Individual
BHAWNA GUPTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2200 EAST WASHINGTON STREET, BLOOMINGTON, IL 61704
(309) 662-3311
Mailing address
1801 TULLAMORE AVENUE, APT 4, BLOOMINGTON, IL 61704
(248) 413-7151
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
IL PT070.018197
IL
Other
Enumeration date
08/29/2012
Last updated
08/29/2012
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