Provider Demographics
NPI:1265929590
Name:VEGA, MARIA A (PTA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:VEGA
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 1:381 OAK TRAILS RD APT 302
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1274
Mailing Address - Country:US
Mailing Address - Phone:708-629-8007
Mailing Address - Fax:
Practice Address - Street 1:1585 BARRINGTON RD STE 101
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-5019
Practice Address - Country:US
Practice Address - Phone:847-884-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.008105225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty