Provider Demographics
NPI:1912468943
Name:GANGABORAIAH, ARPITHA (PT)
Entity Type:Individual
Prefix:
First Name:ARPITHA
Middle Name:
Last Name:GANGABORAIAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 EMERALD LN
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-4208
Mailing Address - Country:US
Mailing Address - Phone:630-917-6116
Mailing Address - Fax:
Practice Address - Street 1:1283 W DUNDEE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4009
Practice Address - Country:US
Practice Address - Phone:847-632-9919
Practice Address - Fax:847-632-9981
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070024069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist