MEDICARE: ROXANNE KHURSHED PESTONJI 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
1	225100000X	Physical Therapist	05009247A	IN
2	225100000X	Physical Therapist	070022297	IL

General Provider Information

NPI Number	:	1336396217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANNE KHURSHED PESTONJI PT

Provider Business Mailing Address
First Line	:	1245 S WOOD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1943
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 S WOOD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1943
Country	:	US
Telephone Number	:	312-421-5220
Fax Number	:

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

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	02/03/2026

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