Individual
DOMINGO BALTAZAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
901 S AUSTIN BLVD, CHICAGO, IL 60644-5311
(773) 287-9181
Mailing address
901 S AUSTIN BLVD, CHICAGO, IL 60644-5311
(773) 287-9181
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
07/12/2011
Last updated
07/12/2011
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