Healthcare Provider Details

I. General information

NPI: 1457298366
Provider Name (Legal Business Name): MAGDALENE MYRDA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SHUMAN BLVD STE 700
NAPERVILLE IL
60563-8422
US

IV. Provider business mailing address

12835 S MASON AVE
PALOS HEIGHTS IL
60463-2344
US

V. Phone/Fax

Practice location:
  • Phone: 708-766-7345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: