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NPI Code Detail

MEDICARE: ELCY DESMANGLES

MEDICARE: ELCY DESMANGLES
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
1225200000XPhysical Therapy Assistant160000594IL

General Provider Information

NPI Number : 1992055933
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELCY DESMANGLES
Provider Business Mailing Address
First Line : 1904 W MORSE AVE APT 1
Second Line :
City : CHICAGO
State : IL
Zip : 60626-3112
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2900 N LAKE SHORE DR
Second Line :
City : CHICAGO
State : IL
Zip : 60657-5640
Country : US
Telephone Number : 773-665-3184
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2012
Last Update Date : 09/18/2012

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Directions to “ ELCY DESMANGLES ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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