Healthcare Provider Details

I. General information

NPI: 1942123476
Provider Name (Legal Business Name): GERARDO ABREGO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6187 S ARCHER AVE
CHICAGO IL
60638-2812
US

IV. Provider business mailing address

2711 S RIDGEWAY AVE
CHICAGO IL
60623-4525
US

V. Phone/Fax

Practice location:
  • Phone: 773-500-2620
  • Fax: 773-500-2630
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160020659
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: