Healthcare Provider Details

I. General information

NPI: 1982174660
Provider Name (Legal Business Name): MONICA DEUTSCH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 W DIVERSEY PKWY
CHICAGO IL
60614-1317
US

IV. Provider business mailing address

2924 N RACINE AVE UNIT 1
CHICAGO IL
60657-4224
US

V. Phone/Fax

Practice location:
  • Phone: 773-248-2578
  • Fax:
Mailing address:
  • Phone: 714-280-6980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number070.026298
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: