Individual
MELVYN GAMBOA GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1420 BUSSE RD, ELK GROVE VILLAGE, IL 60007-5324
(847) 653-0207
Mailing address
700 LANCASTER DR, PINGREE GROVE, IL 60140-9158
(630) 965-5024
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160009247
IL
Other
Enumeration date
09/08/2021
Last updated
09/08/2021
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