Provider Demographics
NPI:1336193507
Name:CUA, GILBERT J (PT)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:J
Last Name:CUA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7401
Mailing Address - Country:US
Mailing Address - Phone:815-337-7100
Mailing Address - Fax:815-337-4793
Practice Address - Street 1:2000 LAKE AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-7401
Practice Address - Country:US
Practice Address - Phone:815-337-7100
Practice Address - Fax:815-337-4793
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007910225100000X
IL070-007910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214660K284502Medicare PIN
IL$$$$$$$$$001 1Medicaid
WICUAGILOtherMERCYCARE INSURANCE