Omar Fonseca

NPI #1366101420 in Woodstock, Illinois

Provider Information

NPI Number: 1366101420
Entity Type: Individual
Name: Omar Fonseca
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Enumeration Date: Dec 15, 2021
Last Updated: Dec 15, 2021

Practice Location

Address: 2000 LAKE AVE
City: Woodstock
State: Illinois
ZIP Code: 60098-7401
Phone: (815) 206-3388

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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