Provider Demographics
NPI:1043022726
Name:REYES, ADALBERTO OSCAR JR (ATC)
Entity type:Individual
Prefix:
First Name:ADALBERTO
Middle Name:OSCAR
Last Name:REYES
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 W 66TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-3426
Mailing Address - Country:US
Mailing Address - Phone:773-697-1538
Mailing Address - Fax:
Practice Address - Street 1:755 PULASKI RD
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-4030
Practice Address - Country:US
Practice Address - Phone:708-585-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0056732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer