MEDICARE: JULIE PISCHKE

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

General Provider Information

NPI Number	:	1275602088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE PISCHKE

Provider Business Mailing Address
First Line	:	21707 W ENGLE DR
Second Line	:
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-9499
Country	:	US
Telephone Number	:	847-356-7830
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 TOWER CT STE A
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-3322
Country	:	US
Telephone Number	:	847-336-7468
Fax Number	:

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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Directions to “ JULIE PISCHKE ” Practice Location

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