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NPI Code Detail

MEDICARE: AUDREY KATHERINE MARKWAY PT, DPT

MEDICARE: AUDREY KATHERINE MARKWAY PT, 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
1225100000XPhysical Therapist070024438IL

General Provider Information

NPI Number : 1053965624
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY KATHERINE MARKWAY PT, DPT
Provider Business Mailing Address
First Line : 1500 N CLYBOURN AVE UNIT C105
Second Line :
City : CHICAGO
State : IL
Zip : 60610-2295
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1500 N CLYBOURN AVE UNIT C105
Second Line :
City : CHICAGO
State : IL
Zip : 60610-2295
Country : US
Telephone Number : 312-202-4216
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2019
Last Update Date : 07/31/2019

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