Provider Demographics
NPI:1215246145
Name:GUOBADIA, EFOSA L (DPT)
Entity type:Individual
Prefix:DR
First Name:EFOSA
Middle Name:L
Last Name:GUOBADIA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 UNIVERSITY DR STE A6
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2385
Practice Address - Country:US
Practice Address - Phone:413-366-5703
Practice Address - Fax:413-992-2019
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
MA27325225100000X
MA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01228273OtherMEDICARE RAILROAD
ILF400161651Medicare PIN
IL216859071Medicare PIN
ILF400161651Medicare PIN