MEDICARE: MRS. JESSICA MCCOOL PHYSICAL THERAPIST

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	225100000X	Physical Therapist		IL

General Provider Information

NPI Number	:	1790881480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA MCCOOL PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	2057 W CUYLER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3005
Country	:	US
Telephone Number	:	614-288-5953
Fax Number	:	773-728-8719

Provider Business Practice Location Address
First Line	:	3130 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3117
Country	:	US
Telephone Number	:	773-525-5200
Fax Number	:	773-525-5276

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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