Provider Demographics
NPI:1194036848
Name:LARRAZABAL, JOHN PHILIP NAVARRO
Entity Type:Individual
Prefix:MR
First Name:JOHN PHILIP
Middle Name:NAVARRO
Last Name:LARRAZABAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 N CUMBERLAND AVE STE A101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-4701
Mailing Address - Country:US
Mailing Address - Phone:773-444-0400
Mailing Address - Fax:
Practice Address - Street 1:5440 N CUMBERLAND AVE STE A101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-4701
Practice Address - Country:US
Practice Address - Phone:773-444-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
208324009Medicare PIN