Provider Demographics
NPI:1811768252
Name:ARCEO, JACKIE FLORES (PTA)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:FLORES
Last Name:ARCEO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3S020 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-1538
Mailing Address - Country:US
Mailing Address - Phone:630-333-0795
Mailing Address - Fax:
Practice Address - Street 1:3S020 SUNSET DR
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-1538
Practice Address - Country:US
Practice Address - Phone:630-333-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.008542225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant