MEDICARE: MS. MEREDY PARKER P.T.

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	070-09700	IL

General Provider Information

NPI Number	:	1144354598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MEREDY PARKER P.T.

Provider Business Mailing Address
First Line	:	3729 N. MAGNOLIA
Second Line	:	#1
City	:	CHICAGO
State	:	IL
Zip	:	60613
Country	:	US
Telephone Number	:	773-857-6773
Fax Number	:

Provider Business Practice Location Address
First Line	:	3548 N. SOUTHPORT AVE.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	66057-1436
Country	:	US
Telephone Number	:	773-755-9214
Fax Number	:	773-755-9216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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