Basic Information
| Provider Information | |||||||||
| NPI: | 1386992881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NADELA | ||||||||
| FirstName: | PEDRO | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17725 CLOVERVIEW DR | ||||||||
| Address2: | |||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604776598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084291624 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10330 S ROBERTS RD | ||||||||
| Address2: | |||||||||
| City: | PALOS HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604651971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082377200 | ||||||||
| FaxNumber: | 7082377296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2012 | ||||||||
| LastUpdateDate: | 05/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070-005720 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.