MEDICARE: ALEJANDRO SOTO PTA

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	225200000X	Physical Therapy Assistant	160007841	IL

General Provider Information

NPI Number	:	1609330075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRO SOTO PTA

Provider Business Mailing Address
First Line	:	2122 S 47TH CT
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 W OGDEN AVE
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-3743
Country	:	US
Telephone Number	:	708-522-1769
Fax Number	:

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

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	01/30/2019

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Directions to “ ALEJANDRO SOTO PTA” Practice Location

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