MEDICARE: MR. EDWARD PATRICK FLAHERTY 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		IL

General Provider Information

NPI Number	:	1407071863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD PATRICK FLAHERTY PT

Provider Business Mailing Address
First Line	:	1206 W WAVELAND AVE
Second Line	:	#1W
City	:	CHICAGO
State	:	IL
Zip	:	60613-3804
Country	:	US
Telephone Number	:	773-477-3509
Fax Number	:	773-477-3520

Provider Business Practice Location Address
First Line	:	1206 W WAVELAND AVE
Second Line	:	#1W
City	:	CHICAGO
State	:	IL
Zip	:	60613-3804
Country	:	US
Telephone Number	:	773-477-3509
Fax Number	:	773-477-3520

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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