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NPI Code Detail

MEDICARE: DEBORAH ANN BIROS PT

MEDICARE: DEBORAH ANN BIROS PT
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 Therapist070002655IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00758838OTHERILMEDICARE RR
2P00943087OTHERILMEDICARE RAILROAD

General Provider Information

NPI Number : 1558499715
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH ANN BIROS PT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9645 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60643-1722
Country : US
Telephone Number : 773-239-2734
Fax Number : 773-239-2784
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 01/13/2015

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