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NPI Code Detail

MEDICARE: MEGAN MCDONALD STULBERG PT, DPT, CCS

MEDICARE:   MEGAN MCDONALD STULBERG  PT, DPT, CCS
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 Therapist070016681IL

General Provider Information

NPI Number : 1225666712
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN MCDONALD STULBERG PT, DPT, CCS
Provider Business Mailing Address
First Line : 5841 S MARYLAND AVE
Second Line : MC 1081, W-107
City : CHICAGO
State : IL
Zip : 60637
Country : US
Telephone Number : 773-702-6891
Fax Number :
Provider Business Practice Location Address
First Line : 5841 S MARYLAND AVE
Second Line : MC 1081, W-107
City : CHICAGO
State : IL
Zip : 60637
Country : US
Telephone Number : 773-702-6891
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2020
Last Update Date : 03/30/2020

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