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NPI Code Detail

MEDICARE: MRS. MELISSA LAUREN PHEE LUETY P.T., D.P.T

MEDICARE: MRS. MELISSA LAUREN PHEE LUETY P.T., D.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
1225100000XPhysical Therapist070.020196IL

General Provider Information

NPI Number : 1154755858
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELISSA LAUREN PHEE LUETY P.T., D.P.T
Provider Business Mailing Address
First Line : 225 S SANGAMON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60607-3196
Country : US
Telephone Number : 312-243-9350
Fax Number :
Provider Business Practice Location Address
First Line : 225 S SANGAMON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60607-3196
Country : US
Telephone Number : 312-243-9350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2013
Last Update Date : 08/29/2013

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