Individual
NICHOLAS FORMICA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
4061 W 95TH ST, OAK LAWN, IL 60453-2611
(630) 469-9200
Mailing address
8825 S KOLMAR AVE, HOMETOWN, IL 60456-1027
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
160010305
IL
Other
Enumeration date
02/11/2025
Last updated
02/11/2025
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