MEDICARE: IMELDA CARMELA BUENO GURDIEL PHYSICAL THERAPIST

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
1	225100000X	Physical Therapist	070.013837	IL

General Provider Information

NPI Number	:	1932362035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMELDA CARMELA BUENO GURDIEL PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	201 W HAMPTON DR
Second Line	:
City	:	ROUND LAKE
State	:	IL
Zip	:	60073-5652
Country	:	US
Telephone Number	:	847-740-5997
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W HAMPTON DR
Second Line	:
City	:	ROUND LAKE
State	:	IL
Zip	:	60073-5652
Country	:	US
Telephone Number	:	847-740-5997
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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