MEDICARE: PT PEARLS, LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1134718976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PT PEARLS, LLC

Provider Business Mailing Address
First Line	:	4513 N KEOKUK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-4220
Country	:	US
Telephone Number	:	773-308-4074
Fax Number	:

Provider Business Practice Location Address
First Line	:	4513 N KEOKUK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-4220
Country	:	US
Telephone Number	:	773-308-4074
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	LORI DIAMOS
Credential	:	PT
Telephone Number	:	773-308-4074

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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Directions to “PT PEARLS, LLC ” Practice Location

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