MEDICARE: CECILIA HORODYSKI 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
1	2251P0200X	Pediatric Physical Therapist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH83440698P	OTHER	IL	EARLY INTERVENTION

General Provider Information

NPI Number	:	1134254840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILIA HORODYSKI PT

Provider Business Mailing Address
First Line	:	2455 N PARKSIDE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2316
Country	:	US
Telephone Number	:	773-622-0188
Fax Number	:

Provider Business Practice Location Address
First Line	:	1951 W 19TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2647
Country	:	US
Telephone Number	:	312-997-2021
Fax Number	:

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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