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NPI Code Detail

MEDICARE: JOANA MEDINA LLANES PT

MEDICARE: JOANA MEDINA LLANES 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
1225100000XPhysical Therapist070.016856IL

General Provider Information

NPI Number : 1215206735
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANA MEDINA LLANES PT
Provider Business Mailing Address
First Line : 4437 S CICERO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4333
Country : US
Telephone Number : 773-884-0484
Fax Number : 773-306-1640
Provider Business Practice Location Address
First Line : 4437 S CICERO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4333
Country : US
Telephone Number : 773-884-0484
Fax Number : 773-306-1640
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2011
Last Update Date : 12/29/2011

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