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NPI Code Detail

MEDICARE: MA DEIANERA ORTINERO

MEDICARE: MA DEIANERA ORTINERO
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
1225100000XPhysical Therapist070.018712IL

General Provider Information

NPI Number : 1053812586
Entity Type Code : Individual
Provider Name (Legal Business Name) : MA DEIANERA ORTINERO
Provider Business Mailing Address
First Line : 2451 W TOUHY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-3309
Country : US
Telephone Number : 773-338-6800
Fax Number :
Provider Business Practice Location Address
First Line : 2451 W TOUHY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-3309
Country : US
Telephone Number : 773-338-6800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2018
Last Update Date : 02/21/2018

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Directions to “ MA DEIANERA ORTINERO ” Practice Location

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