Provider Demographics
NPI:1649508094
Name:ESPINOSA, AGUSTIN ASUIT JR (PT)
Entity type:Individual
Prefix:MR
First Name:AGUSTIN
Middle Name:ASUIT
Last Name:ESPINOSA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 100TH ST
Mailing Address - Street 2:APARTMENT 106
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1242
Mailing Address - Country:US
Mailing Address - Phone:706-581-6457
Mailing Address - Fax:
Practice Address - Street 1:7030 100TH ST
Practice Address - Street 2:APARTMENT 106
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-1242
Practice Address - Country:US
Practice Address - Phone:706-581-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2013-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009429225100000X
FLPT23975225100000X
IL070019548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist