MEDICARE: MALVIKA H SAMPATH 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	070024136	IL

General Provider Information

NPI Number	:	1093287104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALVIKA H SAMPATH DPT

Provider Business Mailing Address
First Line	:	600 OAKMONT LN STE 600C
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5548
Country	:	US
Telephone Number	:	773-871-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1455 W WEBSTER AVE # 4
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3049
Country	:	US
Telephone Number	:	773-871-3100
Fax Number	:	773-871-7388

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

Provider Enumeration Date	:	12/31/2018
Last Update Date	:	12/31/2018

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Directions to “ MALVIKA H SAMPATH DPT” Practice Location

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