Provider Demographics
NPI:1962982744
Name:NOGUEZ, GABRIEL (PT, CSST, CKTP)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:NOGUEZ
Suffix:
Gender:M
Credentials:PT, CSST, CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13649 NATCHEZ TRL
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-1220
Mailing Address - Country:US
Mailing Address - Phone:773-457-8597
Mailing Address - Fax:
Practice Address - Street 1:1023 S CEDAR RD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2645
Practice Address - Country:US
Practice Address - Phone:630-202-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist