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NPI Code Detail

MEDICARE: JASON WALTERS PT

MEDICARE:   JASON  WALTERS  PT
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 TherapistIL

General Provider Information

NPI Number : 1073654968
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON WALTERS PT
Provider Business Mailing Address
First Line : 1644 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-5412
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1644 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-5412
Country : US
Telephone Number : 773-252-2300
Fax Number : 773-252-2319
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 07/08/2007

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Directions to “ JASON WALTERS PT” Practice Location

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