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NPI Code Detail

MEDICARE: SHALLEN FLORY

MEDICARE: SHALLEN FLORY
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 Therapist070020933IL

General Provider Information

NPI Number : 1265833016
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHALLEN FLORY
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2223
Fax Number :
Provider Business Practice Location Address
First Line : 1122 WILLOW RD
Second Line : SUITE A
City : NORTHBROOK
State : IL
Zip : 60062-6824
Country : US
Telephone Number : 847-504-4100
Fax Number : 847-559-7652
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2014
Last Update Date : 10/28/2014

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Directions to “ SHALLEN FLORY ” Practice Location

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