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NPI Code Detail

MEDICARE: KENARR MATOESIAN DPT

MEDICARE: KENARR MATOESIAN 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 Therapist070-024667IL

General Provider Information

NPI Number : 1134716475
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENARR MATOESIAN 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 : 630-575-1980
Fax Number :
Provider Business Practice Location Address
First Line : 24 E CHICAGO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2009
Country : US
Telephone Number : 312-951-9700
Fax Number : 312-951-6989
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2020
Last Update Date : 12/21/2020

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Directions to “ KENARR MATOESIAN DPT” Practice Location

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