MEDICARE: MS. BRIDGID ELLINGSON 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
1	225100000X	Physical Therapist	070008179	IL

General Provider Information

NPI Number	:	1942334743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRIDGID ELLINGSON PT, DPT

Provider Business Mailing Address
First Line	:	4548 N CLAREMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2112
Country	:	US
Telephone Number	:	773-755-9214
Fax Number	:	773-755-9216

Provider Business Practice Location Address
First Line	:	1636 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3018
Country	:	US
Telephone Number	:	773-755-9214
Fax Number	:	773-755-9216

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	01/12/2024

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