Provider Demographics
NPI:1386381812
Name:VIGILAR, CONSUELO DIVINA (PT, DPT)
Entity type:Individual
Prefix:
First Name:CONSUELO DIVINA
Middle Name:
Last Name:VIGILAR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:COCO
Other - Middle Name:
Other - Last Name:VIGILAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:600 N MCCLURG CT APT 1304A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4246
Mailing Address - Country:US
Mailing Address - Phone:248-730-0984
Mailing Address - Fax:
Practice Address - Street 1:9519 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1211
Practice Address - Country:US
Practice Address - Phone:847-390-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.027265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist