MEDICARE: KEVIN J DUFFY II

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		IL

General Provider Information

NPI Number	:	1518020007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN J DUFFY II

Provider Business Mailing Address
First Line	:	605 BEECH LN
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-3325
Country	:	US
Telephone Number	:	815-463-1013
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 BUTTERFIELD RD
Second Line	:	SUITE 308 SOUTH
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1234
Country	:	US
Telephone Number	:	630-573-1979
Fax Number	:

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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