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General NPI Number Information
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NPI Number | 1659058220
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Entity Type | Individual
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Provider Name | MRS. MITHU LIJO
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Gender | Female
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 605 S WOLCOTT AVENUE REHABILITATION SERVICES, 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-864-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 25 W RANDOLPH ST APT 2925
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City | CHICAGO
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State | IL
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Zip | 60601-3526
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Country | US
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Telephone | 832-472-8768
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070026579
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License Number State | IL
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