Healthcare Provider Details

I. General information

NPI: 1710236476
Provider Name (Legal Business Name): HECTOR NAVARRO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2012
Last Update Date: 09/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 175TH ST
LANSING IL
60438-1801
US

IV. Provider business mailing address

5730 VANESSA AVE
PORTAGE IN
46368-5468
US

V. Phone/Fax

Practice location:
  • Phone: 708-474-7330
  • Fax:
Mailing address:
  • Phone: 219-364-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06004436A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: