Provider Demographics
NPI:1316829351
Name:ANDUJAR, TATIANA (PTA)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:ANDUJAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212B COLLEN DR APT 215
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4460
Mailing Address - Country:US
Mailing Address - Phone:630-935-8404
Mailing Address - Fax:
Practice Address - Street 1:1635 S ARDMORE AVE.
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3742
Practice Address - Country:US
Practice Address - Phone:630-935-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.006851225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant