MEDICARE: ERIC C DEAKINS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05008712A	IN
2	225100000X	Physical Therapist	070017505	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000373723	OTHER	IN	ANTHEM - 1ST AID PLUS
2	000000373726	OTHER	IN	ANTHEM - APT PLUS
3	000000373702	OTHER	IN	ANTHEM - MBWOUDE

General Provider Information

NPI Number	:	1013964998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC C DEAKINS DPT

Provider Business Mailing Address
First Line	:	205 W WACKER DR
Second Line	:	SUITE 1020
City	:	CHICAGO
State	:	IL
Zip	:	60606-1216
Country	:	US
Telephone Number	:	312-640-0329
Fax Number	:	312-640-0407

Provider Business Practice Location Address
First Line	:	5230 S BLACKSTONE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4106
Country	:	US
Telephone Number	:	773-256-1475
Fax Number	:	773-256-1481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/13/2014

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