Healthcare Provider Details

I. General information

NPI: 1508084591
Provider Name (Legal Business Name): MELVIN BORJA ESCALONA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S FINLEY RD
LOMBARD IL
60148-7029
US

IV. Provider business mailing address

1815 WINDMILL DR
HANOVER PARK IL
60133-6745
US

V. Phone/Fax

Practice location:
  • Phone: 630-620-5850
  • Fax:
Mailing address:
  • Phone: 630-363-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070015291
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070015291
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: