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General NPI Number Information
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NPI Number | 1306446208
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Entity Type | Individual
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Provider Name | PERRY WILSON GAMON PTA
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Gender | Female
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 220 SPRINGFIELD DR STE 300
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2215
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Country | US
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Telephone | 630-967-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 5336 N LARAMIE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-2204
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Country | US
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Telephone | 630-967-8504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160.009056
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License Number State | IL
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