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NPI Code Detail

MEDICARE: EMMANUEL Y PERA DPT

MEDICARE: EMMANUEL Y PERA 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
1225100000XPhysical Therapist070023140IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1070023140OTHERILSTATE LICENSE

General Provider Information

NPI Number : 1700302080
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMANUEL Y PERA DPT
Provider Business Mailing Address
First Line : 2122 YORK RD STE 300
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-1925
Country : US
Telephone Number : 630-575-1980
Fax Number :
Provider Business Practice Location Address
First Line : 24 E CHICAGO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2009
Country : US
Telephone Number : 312-951-9700
Fax Number : 312-951-6989
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2017
Last Update Date : 02/16/2022

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Directions to “ EMMANUEL Y PERA DPT” Practice Location

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