MEDICARE: ACCESS CARE THERAPEUTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070011407	IL

General Provider Information

NPI Number	:	1043744071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS CARE THERAPEUTICS LLC

Provider Business Mailing Address
First Line	:	3647 W FOSTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5527
Country	:	US
Telephone Number	:	773-715-4565
Fax Number	:

Provider Business Practice Location Address
First Line	:	3647 W FOSTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5527
Country	:	US
Telephone Number	:	773-715-4565
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL EDQUIBAN
Credential	:	PT
Telephone Number	:	773-805-2616

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	04/17/2017

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