MEDICARE: MS. MARIA MOLEK PTA, PART C IEC

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	160-003677	IL

General Provider Information

NPI Number	:	1639207947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA MOLEK PTA, PART C IEC

Provider Business Mailing Address
First Line	:	4837 W ADDISON ST APT 3B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3531
Country	:	US
Telephone Number	:	773-481-2390
Fax Number	:

Provider Business Practice Location Address
First Line	:	4837 W ADDISON ST APT 3B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3531
Country	:	US
Telephone Number	:	847-724-7697
Fax Number	:

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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