Provider Demographics
NPI:1942331806
Name:AGUILAR, MARIO (DT DEVELOPMENT THERA)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:DT DEVELOPMENT THERA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 S HOME AVE
Mailing Address - Street 2:#2
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1618
Mailing Address - Country:US
Mailing Address - Phone:773-505-2357
Mailing Address - Fax:708-788-0967
Practice Address - Street 1:1842 S HOME AVE
Practice Address - Street 2:#2
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1618
Practice Address - Country:US
Practice Address - Phone:773-505-2357
Practice Address - Fax:708-788-0967
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILMA42490698P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist