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General NPI Number Information
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NPI Number | 1992142442
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Entity Type | Organization
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Legal Business Name | MEREDY PARKER PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 3717 N RAVENSWOOD AVE SUITE 213
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City | CHICAGO
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State | IL
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Zip | 60613-3880
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Country | US
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Telephone | 773-368-6176
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 W HUTCHINSON ST
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City | CHICAGO
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State | IL
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Zip | 60613-1312
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Country | US
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Telephone | 773-368-6176
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Fax |
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Authorized Official
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Title or Position | MANAGER/PHYSICAL THERAPIST
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Name | DR. MEREDY A PARKER
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Credential | PT, DPT
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Telephone | 773-368-6176
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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 | 070009700
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License Number State | IL
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