MEDICARE: MARISSA FLUTURE PT

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	070-014205	IL

General Provider Information

NPI Number	:	1164682555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA FLUTURE PT

Provider Business Mailing Address
First Line	:	1929 SPRINGSIDE DR
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-4206
Country	:	US
Telephone Number	:	312-951-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 N DEARBORN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-3846
Country	:	US
Telephone Number	:	312-951-8200
Fax Number	:	312-268-5434

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	05/23/2022

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