Individual
GINA PONGETTI ANGELETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
7055 HIGH GROVE BLVD, BURR RIDGE, IL 60527-7593
(630) 371-1623
(630) 371-1546
Mailing address
100 E WALTON ST, SUITE 700, CHICAGO, IL 60611-1448
(312) 642-3963
(312) 642-3966
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070013170
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1623066
BCBS PROVIDER NUMBER
IL
Enumeration date
06/12/2006
Last updated
10/08/2015
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