Provider Demographics
NPI:1548737562
Name:TOLEDO, ELTON (PTA)
Entity Type:Individual
Prefix:
First Name:ELTON
Middle Name:
Last Name:TOLEDO
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 1:3230 W MARQUETTE RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-3524
Mailing Address - Country:US
Mailing Address - Phone:773-304-8027
Mailing Address - Fax:
Practice Address - Street 1:10300 VILLAGE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-3541
Practice Address - Country:US
Practice Address - Phone:708-329-8891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.008357225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant