MEDICARE: KAREN M LAWVER PTA

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	160.006119	IL

General Provider Information

NPI Number	:	1750622825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN M LAWVER PTA

Provider Business Mailing Address
First Line	:	4334 N CLARENDON AVE
Second Line	:	UNIT 308
City	:	CHICAGO
State	:	IL
Zip	:	60613-6511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4334 N CLARENDON AVE
Second Line	:	UNIT 308
City	:	CHICAGO
State	:	IL
Zip	:	60613-6511
Country	:	US
Telephone Number	:	312-416-3804
Fax Number	:

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

Provider Enumeration Date	:	03/13/2013
Last Update Date	:	03/13/2013

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Directions to “ KAREN M LAWVER PTA” Practice Location

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