MEDICARE: MICHAEL FLORENTINO MITAROTONDO P.T.A.

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	160001922	IL

General Provider Information

NPI Number	:	1326284969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL FLORENTINO MITAROTONDO P.T.A.

Provider Business Mailing Address
First Line	:	2433 N RIDGEWAY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2324
Country	:	US
Telephone Number	:	773-879-2506
Fax Number	:

Provider Business Practice Location Address
First Line	:	2433 N RIDGEWAY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2324
Country	:	US
Telephone Number	:	773-879-2506
Fax Number	:

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

Provider Enumeration Date	:	01/04/2009
Last Update Date	:	01/04/2009

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