Provider Demographics
NPI:1336272368
Name:CORTEZ, NOELLE CHRISTA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:NOELLE
Middle Name:CHRISTA
Last Name:CORTEZ
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 1:2053 N NAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3413
Mailing Address - Country:US
Mailing Address - Phone:708-710-3402
Mailing Address - Fax:
Practice Address - Street 1:7814 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-3536
Practice Address - Country:US
Practice Address - Phone:708-456-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant