=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407031123
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE E STEGEMANN PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2007
-----------------------------------------------------
Last Update Date | 12/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1611 W HARRISON ST SUITE 107
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60612-4861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-432-2513
-----------------------------------------------------
Fax | 312-563-3640
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1611 W HARRISON ST SUITE 107
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60612-4861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-432-2513
-----------------------------------------------------
Fax | 312-563-3640
-----------------------------------------------------
=====================================================
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 | 070009793
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------