Provider Demographics
NPI:1356709596
Name:LUNA, ANGELO MIKHAEL VARQUEZ (PT)
Entity type:Individual
Prefix:
First Name:ANGELO MIKHAEL
Middle Name:VARQUEZ
Last Name:LUNA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2904 BARTLETT CT
Mailing Address - Street 2:UNIT 102
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4900
Mailing Address - Country:US
Mailing Address - Phone:630-418-5154
Mailing Address - Fax:
Practice Address - Street 1:150 HARVESTER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5919
Practice Address - Country:US
Practice Address - Phone:630-246-5100
Practice Address - Fax:630-246-5118
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL070021904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist