Basic Information
| Provider Information | |||||||||
| NPI: | 1467700229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAVALEZA | ||||||||
| FirstName: | BRYAN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4100 HEALTHWAY DR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605044163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308513105 | ||||||||
| FaxNumber: | 6306922168 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 HEALTHWAY DR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308513105 | ||||||||
| FaxNumber: | 6306922168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2012 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070019381 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.