MEDICARE: MRS. LISA CHRISTINE SORKIN 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	225100000X	Physical Therapist		IL

General Provider Information

NPI Number	:	1174675136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA CHRISTINE SORKIN PT

Provider Business Mailing Address
First Line	:	4416 W HUTCHINSON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-1996
Country	:	US
Telephone Number	:	773-427-9029
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 S PAULINA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3808
Country	:	US
Telephone Number	:	312-942-7010
Fax Number	:

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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