Individual
HERCHEL MANGUNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3410 ILLINOIS ST, GREAT LAKES, IL 60088-3120
(224) 610-8553
Mailing address
5019 N SPAULDING AVE, CHICAGO, IL 60625-4911
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
160008649
IL
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
10/16/2024
Last updated
03/19/2025
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