Healthcare Provider Details

I. General information

NPI: 1841599693
Provider Name (Legal Business Name): SONIA AGUIRRE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N LASALLE ST
CHICAGO IL
60614-6005
US

IV. Provider business mailing address

8442 S KARLOV AVE
CHICAGO IL
60652-3104
US

V. Phone/Fax

Practice location:
  • Phone: 312-943-3600
  • Fax: 866-410-9192
Mailing address:
  • Phone: 773-987-1347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160005105
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: