Active NPI
Sandra Maldonado
- Physical Therapy Assistant
- La Grange, IL
National Provider Identifier
1972044386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160.006392
- Practice address
- 4735 Willow Springs Rd
La Grange, IL 60525-6130 - Phone
- (708) 698-5259
- NPI assigned
- Mar 17, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.006392 | IL | Primary |
Addresses
Primary practice location
4735 Willow Springs Rd
La Grange, IL 60525-6130
Mailing address
5112 Madison St
Hillside, IL 60162-1423
Phone (708) 705-4867
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.006392 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489708800000",
"number": "1972044386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5112 MADISON ST",
"city": "HILLSIDE",
"state": "IL",
"postal_code": "601621423",
"telephone_number": "708-705-4867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4735 WILLOW SPRINGS RD",
"city": "LA GRANGE",
"state": "IL",
"postal_code": "605256130",
"telephone_number": "708-698-5259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALDONADO",
"first_name": "SANDRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-17",
"last_updated": "2017-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160.006392",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Grange, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.