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General NPI Number Information
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NPI Number | 1699965608
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Entity Type | Individual
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Provider Name | MILKA PETROVICH THORESEN PT DPT
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Gender | Female
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 5548 S HYDE PARK BLVD
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City | CHICAGO
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State | IL
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Zip | 60637-1909
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Country | US
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Telephone | 773-256-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 3065 E HICKORY LN
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City | CRETE
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State | IL
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Zip | 60417-0532
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Country | US
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Telephone | 708-672-9066
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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 | 17873
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.015994
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License Number State | IL
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