Provider Demographics
NPI:1841599693
Name:AGUIRRE, SONIA (PTA)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8442 S KARLOV AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-3104
Mailing Address - Country:US
Mailing Address - Phone:773-987-1347
Mailing Address - Fax:
Practice Address - Street 1:1620 N LASALLE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6005
Practice Address - Country:US
Practice Address - Phone:312-943-3600
Practice Address - Fax:866-410-9192
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160005105225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL160005105OtherIDFPR