MEDICARE: ELIZABETH ANN URSO 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
1	2251P0200X	Pediatric Physical Therapist		IL

General Provider Information

NPI Number	:	1689860405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN URSO PT

Provider Business Mailing Address
First Line	:	1711 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3019
Country	:	US
Telephone Number	:	773-931-4072
Fax Number	:	773-472-6728

Provider Business Practice Location Address
First Line	:	1711 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3019
Country	:	US
Telephone Number	:	773-931-4072
Fax Number	:	773-472-6728

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

Provider Enumeration Date	:	09/16/2007
Last Update Date	:	09/16/2007

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