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NPI Code Detail

MEDICARE: ERICA NIWA DPT

MEDICARE: ERICA NIWA DPT
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
1225100000XPhysical Therapist070-014357IL

General Provider Information

NPI Number : 1427161629
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA NIWA DPT
Provider Business Mailing Address
First Line : 4080 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60641-1831
Country : US
Telephone Number : 773-545-1153
Fax Number : 773-545-1568
Provider Business Practice Location Address
First Line : 4080 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60641-1831
Country : US
Telephone Number : 773-545-1153
Fax Number : 773-545-1568
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 07/01/2014

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Directions to “ ERICA NIWA DPT” Practice Location

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