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NPI Code Detail

MEDICARE: MICHELINE MENNECKE PHYSICAL THERAPIST

MEDICARE: MICHELINE MENNECKE PHYSICAL THERAPIST
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 TherapistIL

General Provider Information

NPI Number : 1316117351
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELINE MENNECKE PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 9901 LINN STATION RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-3808
Country : US
Telephone Number : 800-866-0860
Fax Number :
Provider Business Practice Location Address
First Line : 1040 ROBEY AVE
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60516-3445
Country : US
Telephone Number : 630-969-9188
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2008
Last Update Date : 03/05/2008

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Directions to “ MICHELINE MENNECKE PHYSICAL THERAPIST” Practice Location

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