MEDICARE: NICOLE CALOMENI PTA

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	225200000X	Physical Therapy Assistant		IL

General Provider Information

NPI Number	:	1225085186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CALOMENI PTA

Provider Business Mailing Address
First Line	:	1021 FULTON AVE
Second Line	:
City	:	WINTHROP HARBOR
State	:	IL
Zip	:	60096-1727
Country	:	US
Telephone Number	:	847-529-2340
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 S RIVERSIDE PLZ
Second Line	:	SUITE 830
City	:	CHICAGO
State	:	IL
Zip	:	60606-5808
Country	:	US
Telephone Number	:	312-416-3804
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/08/2007

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