Provider Demographics
NPI:1679886774
Name:ESCUADRA, THEA (PT)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:
Last Name:ESCUADRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1202
Mailing Address - Country:US
Mailing Address - Phone:847-441-5593
Mailing Address - Fax:
Practice Address - Street 1:14255 CICERO AVE
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60445-2154
Practice Address - Country:US
Practice Address - Phone:708-371-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-17
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013505225100000X
IN05009260A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist