Individual
JAIME MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2762 W ATLANTIC AVE, WAUKEGAN, IL 60085-1587
(847) 436-7776
Mailing address
2762 W ATLANTIC AVE, WAUKEGAN, IL 60085-1587
(847) 436-7776
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160007423
IL
Other
Enumeration date
02/17/2025
Last updated
02/17/2025
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