Healthcare Provider Details

I. General information

NPI: 1710256144
Provider Name (Legal Business Name): ROGELIO CUYOS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S RAND RD
LAKE ZURICH IL
60047-2450
US

IV. Provider business mailing address

900 S RAND RD
LAKE ZURICH IL
60047-2450
US

V. Phone/Fax

Practice location:
  • Phone: 847-726-1200
  • Fax:
Mailing address:
  • Phone: 847-726-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.015773
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: