MEDICARE: CARSON R LUX 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	070008518	IL

General Provider Information

NPI Number	:	1184754244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARSON R LUX PT

Provider Business Mailing Address
First Line	:	600 OAKMONT LN
Second Line	:	STE 600C
City	:	WESTMONT
State	:	IL
Zip	:	60559-5548
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:	630-575-7450

Provider Business Practice Location Address
First Line	:	800 S WELLS ST
Second Line	:	SUITE 137
City	:	CHICAGO
State	:	IL
Zip	:	60607-4529
Country	:	US
Telephone Number	:	312-432-2590
Fax Number	:	312-427-0616

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/27/2018

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