MEDICARE: KAASE GAYL EL-TALABANI

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	160007595	IL

General Provider Information

NPI Number	:	1346794674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAASE GAYL EL-TALABANI

Provider Business Mailing Address
First Line	:	517 E NORTH ST
Second Line	:
City	:	BRADLEY
State	:	IL
Zip	:	60915-1258
Country	:	US
Telephone Number	:	815-802-7503
Fax Number	:	815-802-7514

Provider Business Practice Location Address
First Line	:	517 E NORTH ST
Second Line	:
City	:	BRADLEY
State	:	IL
Zip	:	60915-1258
Country	:	US
Telephone Number	:	815-802-7503
Fax Number	:	815-802-7514

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

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	08/03/2016

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