Provider Demographics
NPI:1760713978
Name:DABA, NESTOR ORTEGA
Entity Type:Individual
Prefix:MR
First Name:NESTOR
Middle Name:ORTEGA
Last Name:DABA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3544 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-3554
Mailing Address - Country:US
Mailing Address - Phone:800-721-8202
Mailing Address - Fax:800-721-8205
Practice Address - Street 1:35 BILLS BLVD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-3354
Practice Address - Country:US
Practice Address - Phone:765-349-9678
Practice Address - Fax:765-349-9719
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017476225100000X
CT8500225100000X
NM3798225100000X
VT0400061049225100000X
IN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist