MEDICARE: ABBY LOPATA 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

General Provider Information

NPI Number	:	1942817390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY LOPATA PT, DPT

Provider Business Mailing Address
First Line	:	329 KINGSTON TER
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-3445
Country	:	US
Telephone Number	:	847-340-0717
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2600
Country	:	US
Telephone Number	:	773-364-1723
Fax Number	:

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

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	09/29/2020

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