Healthcare Provider Details

I. General information

NPI: 1407648579
Provider Name (Legal Business Name): MIGUEL F DE PERALTA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 S DELANO CT E
CHICAGO IL
60605-3457
US

IV. Provider business mailing address

1135 S DELANO CT E
CHICAGO IL
60605-3457
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-1500
  • Fax: 630-933-1550
Mailing address:
  • Phone: 630-933-1500
  • Fax: 630-933-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070029095
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number070.029095
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: