=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285982207
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. SONAL N CHOUDHARY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2012
-----------------------------------------------------
Last Update Date | 08/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 S CALIFORNIA AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60608-1858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-522-2010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 903 S ASHLAND AVE APT 502B
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60607-4002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-953-9006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070.018417
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------