Healthcare Provider Details

I. General information

NPI: 1265929590
Provider Name (Legal Business Name): MARIA A VEGA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 BARRINGTON RD STE 101
HOFFMAN ESTATES IL
60169-5019
US

IV. Provider business mailing address

381 OAK TRAILS RD APT 302
DES PLAINES IL
60016-1274
US

V. Phone/Fax

Practice location:
  • Phone: 847-884-7771
  • Fax:
Mailing address:
  • Phone: 708-629-8007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.008105
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: