Provider Demographics
NPI:1932439684
Name:GOSWAMI, ARCHANA (PT)
Entity Type:Individual
Prefix:
First Name:ARCHANA
Middle Name:
Last Name:GOSWAMI
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 1:4931 S ROUTE 59
Mailing Address - Street 2:UNIT 121
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5705
Mailing Address - Country:US
Mailing Address - Phone:630-355-8022
Mailing Address - Fax:630-355-8032
Practice Address - Street 1:4931 S ROUTE 59
Practice Address - Street 2:UNIT 121
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5705
Practice Address - Country:US
Practice Address - Phone:630-355-8022
Practice Address - Fax:630-355-8032
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist