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NPI Code Detail

MEDICARE: BRADLEY A TROMPETER PT

MEDICARE: BRADLEY A TROMPETER 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 Therapist070017929IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00931626OTHERILMEDICARE RAILROAD
2P00867643OTHERILMEDICARE RAILROAD

General Provider Information

NPI Number : 1275845489
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY A TROMPETER PT
Provider Business Mailing Address
First Line : 10 S CLINTON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60661-3400
Country : US
Telephone Number : 312-234-9958
Fax Number : 312-234-9962
Provider Business Practice Location Address
First Line : 10 S CLINTON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60661-3400
Country : US
Telephone Number : 312-234-9958
Fax Number : 312-234-9962
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2010
Last Update Date : 01/19/2022

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