Provider Demographics
NPI:1174807465
Name:SEGURA, ALBERTO JR (PT)
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:SEGURA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 5TH AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6575
Mailing Address - Country:US
Mailing Address - Phone:646-518-5562
Mailing Address - Fax:212-379-2123
Practice Address - Street 1:3501 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3263
Practice Address - Country:US
Practice Address - Phone:847-818-0461
Practice Address - Fax:847-818-0462
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046157225100000X
IL070-018786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist