Provider Demographics
NPI:1407009509
Name:FLORES, DESI 'AL' (PT)
Entity Type:Individual
Prefix:
First Name:DESI
Middle Name:'AL'
Last Name:FLORES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W COLFAX ST UNIT 2433
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2537
Mailing Address - Country:US
Mailing Address - Phone:847-370-5600
Mailing Address - Fax:
Practice Address - Street 1:3415 W NORTH AVE
Practice Address - Street 2:UNIT A-B
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1017
Practice Address - Country:US
Practice Address - Phone:847-370-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist