Provider Demographics
NPI:1992099592
Name:GARD, JEROD (PT)
Entity type:Individual
Prefix:
First Name:JEROD
Middle Name:
Last Name:GARD
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 1:440 E ROOSEVELT RD STE 104
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-3909
Mailing Address - Country:US
Mailing Address - Phone:630-876-9186
Mailing Address - Fax:
Practice Address - Street 1:440 E ROOSEVELT RD STE 104
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3909
Practice Address - Country:US
Practice Address - Phone:630-876-9186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist