MEDICARE: STEPHANIE NASH

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	225200000X	Physical Therapy Assistant	160.004546	IL

General Provider Information

NPI Number	:	1225302607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE NASH

Provider Business Mailing Address
First Line	:	300 RANDALL RD
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-4200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	296 RANDALL RD
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-4203
Country	:	US
Telephone Number	:	630-208-4215
Fax Number	:

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

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	06/22/2015

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Directions to “ STEPHANIE NASH ” Practice Location

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