MEDICARE: LARISSA WERESZCZAK

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	070.018391	IL

General Provider Information

NPI Number	:	1336418243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARISSA WERESZCZAK

Provider Business Mailing Address
First Line	:	2134 W CORTEZ ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3601
Country	:	US
Telephone Number	:	773-489-6070
Fax Number	:

Provider Business Practice Location Address
First Line	:	7008 WEST CERMAK
Second Line	:
City	:	BERWYN
State	:	IL
Zip	:	60402-2139
Country	:	US
Telephone Number	:	708-795-7040
Fax Number	:	708-795-5664

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

Provider Enumeration Date	:	12/21/2011
Last Update Date	:	12/21/2011

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Directions to “ LARISSA WERESZCZAK ” Practice Location

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