Healthcare Provider Details

I. General information

NPI: 1083344329
Provider Name (Legal Business Name): GIN SOU NGO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 S DELANO CT E
CHICAGO IL
60605-3457
US

IV. Provider business mailing address

1135 S DELANO CT E
CHICAGO IL
60605-3457
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-1500
  • Fax: 630-933-1550
Mailing address:
  • Phone: 630-933-1500
  • Fax: 630-933-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2023009642
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070028954
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: