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General NPI Number Information
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NPI Number | 1811191075
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Entity Type | Individual
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Provider Name | MICHELLE MARIE URBAN PT
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Gender | Female
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2211 N OAK PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60707-3351
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Country | US
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Telephone | 773-385-5574
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Fax | 773-385-5851
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Provider Business Mailing Address
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Address Line | 631 NEWCASTLE AVE
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City | WESTCHESTER
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State | IL
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Zip | 60154-2630
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Country | US
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Telephone | 708-297-5926
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 070007070
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License Number State | IL
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