Herchel Mangune, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

3410 Illinois St
Great Lakes, IL 60088-3120

Phone

(224) 610-8553

NPI assigned

Oct 16, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1467272294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5019 N SPAULDING AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606254911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3410 ILLINOIS ST",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600883120",
            "telephone_number": "224-610-8553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGUNE",
        "first_name": "HERCHEL",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-16",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IL",
            "license": "160008649",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jon Scott Little, IDC
• Ruth Ann Little, LPN
• Kris Eileen Loyd, M.S. CCC-A
• Paul Gerard Luepke, D.D.S., M.S.
• Rodolfo Pineda Manansala, INDEPENDENT DUTY HM
• Ruby Martinez
• Elaine Keefer May, PSY.D.
• Latosha Monique Mayes, PHARM.D.
• Matthew Lamar McCoucha, CRNA NURSE ASSISTANT
• Shirley Walley McCullough, MSW

• Physical Therapy Assistant in Great Lakes, IL
• Providers in Great Lakes, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.