Gonzales, Mia M

Gonzales, Mia M is an individual health care provider with primary practice located at 854 Roosevelt Rd Unit E10 , Glen Ellyn IL 60137-6057. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Gonzales, Mia M can be contacted via phone (630) 967-2000.

Contact Information

Primary practice address
854 Roosevelt Rd Unit E10 Glen Ellyn IL 60137-6057
Phone: (630) 967-2000
Fax: (708) 995-1291
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 070015338 Illinois

Profile Details

NPI number 1215154927
LBN Legal business name Gonzales, Mia M
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 20th, 2007
Last updated May 26th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215154927 NPPES
Illinois Other DC7571 R.R. MEDICARE GROUP #
Illinois Other 1619908 R.R. MEDICARE GROUP #
Illinois Other CJ4383 R.R. MEDICARE GROUP #
Illinois Other 1623066 R.R. MEDICARE GROUP #
Illinois Other 567700 R.R. MEDICARE GROUP #
Illinois Other 367885100 R.R. MEDICARE GROUP #

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