MEDICARE: RENEE HEELAN 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	225100000X	Physical Therapist		IL

General Provider Information

NPI Number	:	1912950841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE HEELAN PT

Provider Business Mailing Address
First Line	:	8930 WAUKEGAN RD
Second Line	:	SUITE 200 - ATTN: RAQUEL LEON
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2126
Country	:	US
Telephone Number	:	847-324-3976
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 S GREENLEAF ST
Second Line	:	SUITE 405
City	:	GURNEE
State	:	IL
Zip	:	60031-5709
Country	:	US
Telephone Number	:	847-596-7640
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/28/2007

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