Individual
BLAKELY R PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
24 E CHICAGO AVE, CHICAGO, IL 60611-2009
(312) 951-9700
(312) 951-6989
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
(630) 575-6200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PENDING
IL
Other
Enumeration date
03/14/2023
Last updated
03/14/2023
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