Provider Demographics
NPI:1477063311
Name:TAMAYO URGELLO, ANTON DOMINIC (DPT)
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:DOMINIC
Last Name:TAMAYO URGELLO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-585-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:4700 GILBERT AVE STE 43A
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1670
Practice Address - Country:US
Practice Address - Phone:708-783-1044
Practice Address - Fax:708-783-1048
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-027641225100000X
OK5387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist