Provider Demographics
NPI:1326284969
Name:MITAROTONDO, MICHAEL FLORENTINO (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FLORENTINO
Last Name:MITAROTONDO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 N RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2324
Mailing Address - Country:US
Mailing Address - Phone:773-879-2506
Mailing Address - Fax:
Practice Address - Street 1:2433 N RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2324
Practice Address - Country:US
Practice Address - Phone:773-879-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-04
Last Update Date:2009-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160001922225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant