Healthcare Provider Details

I. General information

NPI: 1700739521
Provider Name (Legal Business Name): ARMAND BRACERO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3973 W ALGONQUIN RD
ALGONQUIN IL
60102-9700
US

IV. Provider business mailing address

55 HAMILTON AVE
ELGIN IL
60123-5305
US

V. Phone/Fax

Practice location:
  • Phone: 224-348-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.010611
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: