Healthcare Provider Details

I. General information

NPI: 1215983655
Provider Name (Legal Business Name): MANASI KAMDAR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 S BLACKSTONE AVE
CHICAGO IL
60615-4106
US

IV. Provider business mailing address

901 S ASHLAND AVE #1011
CHICAGO IL
60607-4001
US

V. Phone/Fax

Practice location:
  • Phone: 773-256-1475
  • Fax: 773-256-1481
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: