Provider Demographics
NPI:1609248947
Name:ARISTON, MARIA ROSELYN CAPILI (PT)
Entity Type:Individual
Prefix:
First Name:MARIA ROSELYN
Middle Name:CAPILI
Last Name:ARISTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA ROSELYN
Other - Middle Name:CAPILI
Other - Last Name:LLOBRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:460 MIRA ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-3529
Mailing Address - Country:US
Mailing Address - Phone:815-444-8580
Mailing Address - Fax:
Practice Address - Street 1:460 MIRA ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-3529
Practice Address - Country:US
Practice Address - Phone:815-444-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist