Provider Demographics
NPI:1003407420
Name:FRIAS-PARTIDA, ALVARO (ATC)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:
Last Name:FRIAS-PARTIDA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 HOMEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2528
Mailing Address - Country:US
Mailing Address - Phone:630-235-8382
Mailing Address - Fax:
Practice Address - Street 1:334 HOMEWOOD DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2528
Practice Address - Country:US
Practice Address - Phone:630-235-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0045982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer