Provider Demographics
NPI:1801515671
Name:IGNACO, JUSTIN RAPHAEL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JUSTIN RAPHAEL
Middle Name:
Last Name:IGNACO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 WILLOW RD STE L
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7637
Mailing Address - Country:US
Mailing Address - Phone:630-933-1500
Mailing Address - Fax:630-933-1550
Practice Address - Street 1:2301 WILLOW RD STE L
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7637
Practice Address - Country:US
Practice Address - Phone:630-933-1500
Practice Address - Fax:630-933-1550
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT302598225100000X
IL070027148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist