Healthcare Provider Details

I. General information

NPI: 1184552408
Provider Name (Legal Business Name): JONATHAN S LABRADO CARDENAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3726 S 53RD CT
CICERO IL
60804-4424
US

IV. Provider business mailing address

3726 S 53RD CT
CICERO IL
60804-4424
US

V. Phone/Fax

Practice location:
  • Phone: 708-833-0213
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.010499
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: