MEDICARE: SHAUN TU 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	2251P0200X	Pediatric Physical Therapist
2	225100000X	Physical Therapist	070.022961	IL

General Provider Information

NPI Number	:	1417476300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUN TU PT

Provider Business Mailing Address
First Line	:	1748 N HONORE ST APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-0097
Country	:	US
Telephone Number	:	650-387-2323
Fax Number	:

Provider Business Practice Location Address
First Line	:	2659 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3013
Country	:	US
Telephone Number	:	773-252-4921
Fax Number	:	773-252-5067

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

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	11/26/2021

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Directions to “ SHAUN TU PT” Practice Location

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