Provider Demographics
NPI:1871227744
Name:VALENZUELA, LUCIA SUSANA (DPT)
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:SUSANA
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4307 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4008
Practice Address - Country:US
Practice Address - Phone:773-916-4673
Practice Address - Fax:773-847-7868
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302364225100000X
OR65106225100000X
IL070.026650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist