Healthcare Provider Details

I. General information

NPI: 1487564407
Provider Name (Legal Business Name): PABLO DE LA CRUZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 N HARLEM AVE
OAK PARK IL
60302-1529
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 708-386-2086
  • Fax: 708-386-3028
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070041133
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: