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General NPI Number Information
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NPI Number | 1851333694
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Entity Type | Individual
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Provider Name | GINA PONGETTI ANGELETTI MPT
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Gender | Female
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 7055 HIGH GROVE BLVD
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City | BURR RIDGE
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State | IL
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Zip | 60527-7593
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Country | US
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Telephone | 630-371-1623
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Fax | 630-371-1546
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Provider Business Mailing Address
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Address Line | 100 E WALTON ST SUITE 700
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City | CHICAGO
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State | IL
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Zip | 60611-1448
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Country | US
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Telephone | 312-642-3963
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Fax | 312-642-3966
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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 | 070013170
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License Number State | IL
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