MEDICARE: DR. MIGUEL F DE PERALTA DPT

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	070029095	IL
2	2251N0400X	Neurology Physical Therapist	070.029095	IL

General Provider Information

NPI Number	:	1407648579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGUEL F DE PERALTA DPT

Provider Business Mailing Address
First Line	:	1135 S DELANO CT E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-3457
Country	:	US
Telephone Number	:	630-933-1500
Fax Number	:	630-933-1550

Provider Business Practice Location Address
First Line	:	1135 S DELANO CT E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-3457
Country	:	US
Telephone Number	:	630-933-1500
Fax Number	:	630-933-1550

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

Provider Enumeration Date	:	05/22/2025
Last Update Date	:	04/21/2026

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