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NPI Code Detail

MEDICARE: MILKA PETROVICH THORESEN PT DPT

MEDICARE: MILKA PETROVICH THORESEN PT DPT
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 Therapist17873MA
2225100000XPhysical Therapist070.015994IL

General Provider Information

NPI Number : 1699965608
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILKA PETROVICH THORESEN PT DPT
Provider Business Mailing Address
First Line : 3065 E HICKORY LN
Second Line :
City : CRETE
State : IL
Zip : 60417-0532
Country : US
Telephone Number : 708-672-9066
Fax Number :
Provider Business Practice Location Address
First Line : 5548 S HYDE PARK BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60637-1909
Country : US
Telephone Number : 773-256-5050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2007
Last Update Date : 04/30/2008

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Directions to “ MILKA PETROVICH THORESEN PT DPT” Practice Location

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