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NPI Code Detail

MEDICARE: TARA C EGAN PT

MEDICARE:   TARA C EGAN  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
1174400000XSpecialist70013383IL

General Provider Information

NPI Number : 1730371535
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA C EGAN PT
Provider Business Mailing Address
First Line : 2009 W ARGYLE ST # 1
Second Line :
City : CHICAGO
State : IL
Zip : 60625-1312
Country : US
Telephone Number : 773-988-6629
Fax Number :
Provider Business Practice Location Address
First Line : 2009 W ARGYLE ST # 1
Second Line :
City : CHICAGO
State : IL
Zip : 60625-1312
Country : US
Telephone Number : 773-988-6629
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2007
Last Update Date : 08/15/2007

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Directions to “ TARA C EGAN PT” Practice Location

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