Provider Demographics
NPI:1225722374
Name:OCHOA, JORGE FERNANDO (DPT, PT)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:FERNANDO
Last Name:OCHOA
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CANNONBALL TRL
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:IL
Mailing Address - Zip Code:60512-1000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1919 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7246
Practice Address - Country:US
Practice Address - Phone:872-302-7816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070027540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist