Omar Fonseca

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160.009394 Issued in IL

Practice address

2000 Lake Ave
Woodstock, IL 60098-7401

Phone

(815) 206-3388

NPI assigned

Dec 15, 2021

Last updated

Dec 15, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1639526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1366101420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 DEERPATH DR",
            "city": "GENOA CITY",
            "state": "WI",
            "postal_code": "531282504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 LAKE AVE",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600987401",
            "telephone_number": "815-206-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONSECA",
        "first_name": "OMAR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-15",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160.009394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick H Flanagan, LICENSED ORTHOTIC
• Gabriela Flores
• Genaro Flores
• Marciana E Flores, MD
• Talya Mercedes Flores, OTD, OTR/L
• Apiwat Ford, DO
• Louise K Forrest
• Cindy Jo Forster-Fueredi, PSY.D.
• Fox Valley Mobile PT
• Meredith Foydl

• Physical Therapy Assistant in Woodstock, IL
• Providers in Woodstock, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.