MEDICARE: LUCAS BELTRAN

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	070-0244770	IL

General Provider Information

NPI Number	:	1922887736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS BELTRAN

Provider Business Mailing Address
First Line	:	900 RAND RD STE 300
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-2359
Country	:	US
Telephone Number	:	847-324-3976
Fax Number	:	847-929-1154

Provider Business Practice Location Address
First Line	:	19558 S HARLEM AVE STE 4
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-6743
Country	:	US
Telephone Number	:	815-806-0019
Fax Number	:	779-254-2927

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

Provider Enumeration Date	:	09/22/2023
Last Update Date	:	09/22/2023

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Directions to “ LUCAS BELTRAN ” Practice Location

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