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NPI Code Detail

MEDICARE: GUSTAVO CABAGNA PT

MEDICARE: GUSTAVO CABAGNA PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistIL

General Provider Information

NPI Number : 1659382406
Entity Type Code : Individual
Provider Name (Legal Business Name) : GUSTAVO CABAGNA PT
Provider Business Mailing Address
First Line : 1749 N WELLS ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-5877
Country : US
Telephone Number : 312-440-9646
Fax Number : 866-869-9780
Provider Business Practice Location Address
First Line : 1749 N WELLS ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-5877
Country : US
Telephone Number : 312-440-9646
Fax Number : 866-869-9780
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2006
Last Update Date : 07/08/2007

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Directions to “ GUSTAVO CABAGNA PT” Practice Location

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