Healthcare Provider Details

I. General information

NPI: 1568974087
Provider Name (Legal Business Name): JONATHAN CULTURA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 JOLIET ST
DYER IN
46311-1793
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 219-864-0290
  • Fax:
Mailing address:
  • Phone: 574-233-5754
  • Fax: 574-233-7406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05012426A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: