Provider Demographics
NPI:1871325183
Name:ALVAREZ, JOSE LUIS (PTA)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 BELMONT RD APT 7
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3249
Mailing Address - Country:US
Mailing Address - Phone:815-791-0616
Mailing Address - Fax:
Practice Address - Street 1:4835 BELMONT RD APT 7
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3249
Practice Address - Country:US
Practice Address - Phone:815-791-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160010175225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant