MEDICARE: MELISSA DAWN SGROI MSPT

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	40QA01142000	NJ
2	225100000X	Physical Therapist	070019014	IL

General Provider Information

NPI Number	:	1629166913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA DAWN SGROI MSPT

Provider Business Mailing Address
First Line	:	205 W WACKER DR
Second Line	:	SUITE 1020
City	:	CHICAGO
State	:	IL
Zip	:	60606-1216
Country	:	US
Telephone Number	:	312-640-0329
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 N LASALLE STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-0000
Country	:	US
Telephone Number	:	312-855-9206
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/09/2012

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Directions to “ MELISSA DAWN SGROI MSPT” Practice Location

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