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General NPI Number Information
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NPI Number | 1366172025
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Entity Type | Individual
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Provider Name | JONATHON JAMES CERQUA DPT
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Gender | Male
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 920 MILWAUKEE AVE
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069-3839
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Country | US
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Telephone | 847-204-8376
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Fax |
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Provider Business Mailing Address
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Address Line | 4525 SHOREWOOD DR N
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60192-1020
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Country | US
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Telephone | 847-204-8376
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 070023098
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License Number State | IL
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