Healthcare Provider Details

I. General information

NPI: 1447160577
Provider Name (Legal Business Name): ERIK ESQUIVEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 PENNSYLVANIA AVE
GLEN ELLYN IL
60137-4464
US

IV. Provider business mailing address

100 WINDSOR LN
GLENDALE HEIGHTS IL
60139-3024
US

V. Phone/Fax

Practice location:
  • Phone: 630-469-9200
  • Fax:
Mailing address:
  • Phone: 630-636-1346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.010271
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: