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General NPI Number Information
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NPI Number | 1851168892
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Entity Type | Individual
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Provider Name | EDGE CLAUDIUS MAGTOTO NOCOM PT
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Gender | Male
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 7511 LEMONT RD STE 204
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City | DARIEN
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State | IL
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Zip | 60561-4386
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Country | US
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Telephone | 630-985-4010
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Fax | 630-985-4056
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 07027953
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License Number State | IL
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