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General NPI Number Information
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NPI Number | 1851091235
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Entity Type | Individual
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Provider Name | ADRIAN TELLEZ
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Gender | Male
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 8317 OGDEN AVE
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City | LYONS
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State | IL
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Zip | 60534-1122
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Country | US
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Telephone | 847-818-0461
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Fax | 847-305-2917
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Provider Business Mailing Address
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Address Line | 33900 HARPER AVE STE 104
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City | CLINTON TWP
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State | MI
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Zip | 48035-4258
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Country | US
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Telephone |
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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 | 160.009853
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License Number State | IL
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