MEDICARE: MS. BARBARA ANN PENZATO MPT

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	070.009256	IL

General Provider Information

NPI Number	:	1396037115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA ANN PENZATO MPT

Provider Business Mailing Address
First Line	:	123 N 6TH ST
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-1707
Country	:	US
Telephone Number	:	630-675-9171
Fax Number	:

Provider Business Practice Location Address
First Line	:	964 N 5TH AVE
Second Line	:	BLDG C
City	:	ST CHARLES
State	:	IL
Zip	:	60174-1204
Country	:	US
Telephone Number	:	630-443-8202
Fax Number	:

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

Provider Enumeration Date	:	05/12/2011
Last Update Date	:	05/12/2011

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