Provider Demographics
NPI:1760879969
Name:MONTEMAYOR, JOSEPH ALBERT DE MESA (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH ALBERT
Middle Name:DE MESA
Last Name:MONTEMAYOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 N OTTAWA AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3108
Mailing Address - Country:US
Mailing Address - Phone:773-844-8231
Mailing Address - Fax:
Practice Address - Street 1:3639 N OTTAWA AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3108
Practice Address - Country:US
Practice Address - Phone:773-844-8231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-25
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700156642251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics