MEDICARE: ELIZABETH CAMPIONE PT, DPT

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		IL

General Provider Information

NPI Number	:	1275680894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH CAMPIONE PT, DPT

Provider Business Mailing Address
First Line	:	4226 N KENMORE AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-1489
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3800
Country	:	US
Telephone Number	:	312-942-5847
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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