MEDICARE: MADELYN NEGAARD 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	:	1386380400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELYN NEGAARD DPT

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:	630-575-7450

Provider Business Practice Location Address
First Line	:	1246 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3207
Country	:	US
Telephone Number	:	773-888-5480
Fax Number	:	773-888-5481

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

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	05/11/2022

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