MEDICARE: ADDISON PHYSICAL MEDICINE AND REHABILITATION CENTER LTD.

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	111N00000X	Chiropractor	038008124	IL
2	225100000X	Physical Therapist		IL
3	111N00000X	Chiropractor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02222753	OTHER	IL	BC
2	02222753	OTHER	IL	BCBSIL

General Provider Information

NPI Number	:	1407853393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDISON PHYSICAL MEDICINE AND REHABILITATION CENTER LTD.

Provider Business Mailing Address
First Line	:	199 S. ADDISON RD.
Second Line	:	SUITE #106
City	:	WOOD DALE
State	:	IL
Zip	:	60191-1534
Country	:	US
Telephone Number	:	630-766-1552
Fax Number	:	630-766-4220

Provider Business Practice Location Address
First Line	:	199 S. ADDISON RD.
Second Line	:	SUITE #106
City	:	WOOD DALE
State	:	IL
Zip	:	60191-1534
Country	:	US
Telephone Number	:	630-766-1552
Fax Number	:	630-766-4220

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD MICHAEL KRYS
Credential	:	D.C.
Telephone Number	:	630-766-1552

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/21/2022

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Directions to “ADDISON PHYSICAL MEDICINE AND REHABILITATION CENTER LTD. ” Practice Location

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