Individual
BUEN VIDAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11508 W 183RD ST, ORLAND PARK, IL 60467-9487
(170) 832-6155
Mailing address
1851 MAPLE AVE, BERWYN, IL 60402-1549
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160005627
IL
Other
Enumeration date
04/03/2014
Last updated
04/03/2014
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