Healthcare Provider Details

I. General information

NPI: 1942437405
Provider Name (Legal Business Name): ADRIANA OSSA-CRUZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S MICHIGAN AVE STE 1441
CHICAGO IL
60603-6173
US

IV. Provider business mailing address

122 S MICHIGAN AVE STE 1441
CHICAGO IL
60603-6173
US

V. Phone/Fax

Practice location:
  • Phone: 312-986-9833
  • Fax: 312-962-8855
Mailing address:
  • Phone: 773-250-0500
  • Fax: 773-250-0497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-016838
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT38823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: