Healthcare Provider Details

I. General information

NPI: 1376357798
Provider Name (Legal Business Name): JESUS ALEXANDER GARCIA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 26TH ST
CHICAGO IL
60616-1806
US

IV. Provider business mailing address

2822 S 50TH CT APT 2
CICERO IL
60804-3532
US

V. Phone/Fax

Practice location:
  • Phone: 312-579-4985
  • Fax:
Mailing address:
  • Phone: 708-657-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160009485
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: