Individual
JOHN MICHAEL AGSAO FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2655 W PETERSON AVE # 60659, CHICAGO, IL 60659-4017
(224) 715-6741
Mailing address
2655 W PETERSON AVE, CHICAGO, IL 60659-4017
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160008094
IL
Other
Enumeration date
12/17/2021
Last updated
12/17/2021
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