MEDICARE: MR. AGUSTIN ASUIT ESPINOSA JR. PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT009429	GA
2	225100000X	Physical Therapist	PT23975	FL
3	225100000X	Physical Therapist	070019548	IL

General Provider Information

NPI Number	:	1649508094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AGUSTIN ASUIT ESPINOSA JR. PT

Provider Business Mailing Address
First Line	:	7030 100TH ST
Second Line	:	APARTMENT 106
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-1242
Country	:	US
Telephone Number	:	706-581-6457
Fax Number	:

Provider Business Practice Location Address
First Line	:	7030 100TH ST
Second Line	:	APARTMENT 106
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-1242
Country	:	US
Telephone Number	:	706-581-6457
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2009
Last Update Date	:	10/13/2013

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