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General NPI Number Information
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NPI Number | 1336735315
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Entity Type | Individual
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Provider Name | CRYSTAL GOMEZ PT
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Gender | Female
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Dates
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Enumeration Date | 12/14/2020
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 2020 N LINCOLN PARK W APT 36K
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City | CHICAGO
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State | IL
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Zip | 60614-4733
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Country | US
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Telephone | 760-662-0130
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 N LINCOLN PARK W APT 36K
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City | CHICAGO
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State | IL
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Zip | 60614-4733
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.025507
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070025507
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License Number State | IL
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