Healthcare Provider Details

I. General information

NPI: 1386381812
Provider Name (Legal Business Name): CONSUELO DIVINA VIGILAR PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COCO VIGILAR

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9519 N MILWAUKEE AVE
NILES IL
60714-1211
US

IV. Provider business mailing address

600 N MCCLURG CT APT 1304A
CHICAGO IL
60611-4246
US

V. Phone/Fax

Practice location:
  • Phone: 847-390-0999
  • Fax:
Mailing address:
  • Phone: 248-730-0984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.027265
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: