MEDICARE: AUTUMN MARIA ESPINOSA PT, 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

General Provider Information

NPI Number	:	1588407704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN MARIA ESPINOSA PT, DPT

Provider Business Mailing Address
First Line	:	433 CLINTON AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-3706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	517 MADISON ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-4406
Country	:	US
Telephone Number	:	708-628-8008
Fax Number	:

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

Provider Enumeration Date	:	06/15/2024
Last Update Date	:	06/15/2024

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