MEDICARE: ANGELI JUSTINE CHAVEZ MATA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070-026976	IL

General Provider Information

NPI Number	:	1386427110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELI JUSTINE CHAVEZ MATA

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	5304 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2312
Country	:	US
Telephone Number	:	630-368-1771
Fax Number	:	708-658-2750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	02/16/2026

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