Provider Demographics
NPI:1083182760
Name:CABRAL, ELIAS JR (PTA)
Entity type:Individual
Prefix:MR
First Name:ELIAS
Middle Name:
Last Name:CABRAL
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 W CORNELIA AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5004
Mailing Address - Country:US
Mailing Address - Phone:616-450-4059
Mailing Address - Fax:
Practice Address - Street 1:3834 W CORNELIA AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5004
Practice Address - Country:US
Practice Address - Phone:616-450-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.008005225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant