MEDICARE: ABC4WELLNESS, LTD.

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	261QP2000X	Physical Therapy Clinic/Center	070015149	IL

General Provider Information

NPI Number	:	1952705154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC4WELLNESS, LTD.

Provider Business Mailing Address
First Line	:	811 DAMICO DRIVE
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1934
Country	:	US
Telephone Number	:	708-560-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 DAMICO DR
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1934
Country	:	US
Telephone Number	:	708-560-1611
Fax Number	:

Authorized Official
Title or Position	:	PT / OWNER
Name	:	MS. LINDA M. KRISTINA
Credential	:	PT
Telephone Number	:	708-560-1611

Provider Enumeration Date	:	10/16/2014
Last Update Date	:	10/16/2014

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Directions to “ABC4WELLNESS, LTD. ” Practice Location

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