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NPI Code Detail

MEDICARE: ANDREA RUTH ALTER

MEDICARE: ANDREA RUTH ALTER
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 Therapist070019371IL

General Provider Information

NPI Number : 1477802817
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA RUTH ALTER
Provider Business Mailing Address
First Line : 1308 WAUKEGAN RD
Second Line : SUITE 103
City : GLENVIEW
State : IL
Zip : 60025-3070
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1657 W CORTLAND ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1119
Country : US
Telephone Number : 847-486-4140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2012
Last Update Date : 08/30/2012

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Directions to “ ANDREA RUTH ALTER ” Practice Location

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