Healthcare Provider Details

I. General information

NPI: 1003407420
Provider Name (Legal Business Name): ALVARO FRIAS-PARTIDA ATC, RKT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

334 HOMEWOOD DR
BOLINGBROOK IL
60440-2528
US

V. Phone/Fax

Practice location:
  • Phone: 630-235-8382
  • Fax:
Mailing address:
  • Phone: 630-235-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.004598
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number2189
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: