MEDICARE: PATRICIA LINDA NOOTBAAR P.T.PCS.

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	:	1407988736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LINDA NOOTBAAR P.T.PCS.

Provider Business Mailing Address
First Line	:	1572 BUNESCU LN
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1250
Country	:	US
Telephone Number	:	847-913-9311
Fax Number	:	847-913-9311

Provider Business Practice Location Address
First Line	:	1572 BUNESCU LN
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1250
Country	:	US
Telephone Number	:	847-913-9311
Fax Number	:	847-913-9311

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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