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General NPI Number Information
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NPI Number | 1811655905
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Entity Type | Individual
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Provider Name | RAUL E SILVA JR.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 1835 W HARRISON ST
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City | CHICAGO
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State | IL
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Zip | 60612-3771
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Country | US
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Telephone | 312-964-3651
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Fax |
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Provider Business Mailing Address
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Address Line | 2438 S AUSTIN BLVD
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City | CICERO
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State | IL
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Zip | 60804-2681
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Country | US
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Telephone | 708-310-0926
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 16.003791
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License Number State | IL
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