Individual provider Active NPI

Evangeline Velasquez Soltes, PT

  • Physical Therapist
  • Roscoe, IL
National Provider Identifier
1336434802
Registry record updated Jun 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.014275 Issued in IL
Practice address
9154 Leicester Way
Roscoe, IL 61073-7133
Phone
(630) 229-8745
NPI assigned
Jun 13, 2011
Last updated
Jun 13, 2011By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070.014275 IL Primary

Addresses

Primary practice location

9154 Leicester Way
Roscoe, IL 61073-7133

Mailing address

9154 Leicester Way
Roscoe, IL 61073-7133
Phone (630) 229-8745

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200515000377 IL Practitioner - Physical Therapist in Private Practice 2961833579 Reassigns benefits to 2 organizations
I20220127000073 WI Practitioner - Physical Therapist in Private Practice 2961833579 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aegis Group Practice LLCGroup PAC ID 5193036432, 399 clinicians

Practice addresses (Care Compare)

3470 N Alpine Rd
Rockford, IL 61114-4802
Phone (815) 997-7919

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.014275ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation Current Accepting new patients
Mercy Health System Corporation CurrentSince Nov 1, 2021 Accepting new patients
Mercy Health System Corporation CurrentSince Nov 1, 2021 Accepting new patients
Aegis Group Practice LLC Physical Therapist CurrentSince Jan 7, 2026 Accepting new patients
Aegis Group Practice LLC Physical Therapist CurrentSince Jan 7, 2026 Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

1920 Maple Ave
Lisle, IL 60532
Phone (630) 725-7000

3470 N Alpine Rd
Rockford, IL 61114
Phone (815) 668-7333

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

N2950 State Road 67
Lake Geneva, WI 53147
Phone (262) 245-0535

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307923200000",
    "number": "1336434802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9154 LEICESTER WAY",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610737133",
            "telephone_number": "630-229-8745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9154 LEICESTER WAY",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610737133",
            "telephone_number": "630-229-8745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLTES",
        "first_name": "EVANGELINE",
        "middle_name": "VELASQUEZ",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-13",
        "last_updated": "2011-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.014275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roscoe, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.