Healthcare Provider Details

I. General information

NPI: 1740680164
Provider Name (Legal Business Name): KARA MATHYS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 S STATE ST
CHICAGO IL
60605-2304
US

IV. Provider business mailing address

1131 S STATE ST
CHICAGO IL
60605-2304
US

V. Phone/Fax

Practice location:
  • Phone: 312-877-5101
  • Fax:
Mailing address:
  • Phone: 312-877-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070020956
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: