MEDICARE: SVETLANA BODNYA 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		IL

General Provider Information

NPI Number	:	1952524795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA BODNYA PTA

Provider Business Mailing Address
First Line	:	701 FORUM SQ UNIT 308
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-3864
Country	:	US
Telephone Number	:	847-768-0426
Fax Number	:

Provider Business Practice Location Address
First Line	:	5061 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2706
Country	:	US
Telephone Number	:	708-349-6544
Fax Number	:

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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