Provider Demographics
NPI:1790817369
Name:NAVARRO, CAROL JAY (PTA,ATC)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JAY
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:PTA,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CINDERFORD CT
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:413 CHICAGO ROAD
Practice Address - Street 2:NEWARK HIGH SCHOOL
Practice Address - City:NEWARK
Practice Address - State:IL
Practice Address - Zip Code:60541
Practice Address - Country:US
Practice Address - Phone:815-695-5164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960003032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer