Provider Demographics
NPI:1215417076
Name:MAGTIRA, RODOLFO Y
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:Y
Last Name:MAGTIRA
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 1:840 FOXWORTH BLVD APT 311
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4897
Mailing Address - Country:US
Mailing Address - Phone:708-691-7252
Mailing Address - Fax:
Practice Address - Street 1:840 FOXWORTH BLVD APT 311
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4897
Practice Address - Country:US
Practice Address - Phone:708-691-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist