Provider Demographics
NPI:1215094404
Name:GERTSEN, MICHELE (PT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:GERTSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:3344 S ROUTE 59
Practice Address - Street 2:UNIT 100
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8139
Practice Address - Country:US
Practice Address - Phone:630-778-9880
Practice Address - Fax:630-778-9897
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-007858OtherPT STATE LICENSE #
IL146636Medicare ID - Type Unspecified