MEDICARE: PAMELA JEAN BYRNE 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	:	1326196171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA JEAN BYRNE PT, DPT

Provider Business Mailing Address
First Line	:	593 N PLUM GROVE RD
Second Line	:	APT 1B
City	:	ROSELLE
State	:	IL
Zip	:	60172-1369
Country	:	US
Telephone Number	:	708-288-4942
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 S PAULINA ST
Second Line	:	4JRB PHYSICAL THERAPY
City	:	CHICAGO
State	:	IL
Zip	:	60612-3808
Country	:	US
Telephone Number	:	312-942-7010
Fax Number	:

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

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

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