Provider Demographics
NPI:1760702625
Name:HERMOSILLO, VICTOR (DPT)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:HERMOSILLO
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:PO BOX 416501 STE 140
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5548
Mailing Address - Country:US
Mailing Address - Phone:910-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:840 WILLOW RD STE P
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6823
Practice Address - Country:US
Practice Address - Phone:224-649-5600
Practice Address - Fax:224-333-1444
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61391225100000X
IL070023397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist