Healthcare Provider Details

I. General information

NPI: 1295676492
Provider Name (Legal Business Name): JESSICA BRITTANY LUNA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 MCDANIEL AVE
EVANSTON IL
60201-2549
US

IV. Provider business mailing address

2636 N 72ND CT
ELMWOOD PARK IL
60707-1650
US

V. Phone/Fax

Practice location:
  • Phone: 877-525-5832
  • Fax:
Mailing address:
  • Phone: 773-668-4042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160010392
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: