Provider Demographics
NPI:1861660581
Name:CABRERA, JOSEPHA NINA FIDELINO (PT)
Entity type:Individual
Prefix:MS
First Name:JOSEPHA NINA
Middle Name:FIDELINO
Last Name:CABRERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:FIDELINO
Other - Last Name:CABRERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:1747 E 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4708
Practice Address - Country:US
Practice Address - Phone:773-375-8711
Practice Address - Fax:773-375-8703
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70014269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist