MEDICARE: STACEY L KNOWLES M.S.P.T.

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	070009716	IL

General Provider Information

NPI Number	:	1437187069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY L KNOWLES M.S.P.T.

Provider Business Mailing Address
First Line	:	4636 N RAVENSWOOD AVE STE 101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4578
Country	:	US
Telephone Number	:	773-516-4146
Fax Number	:	773-961-7922

Provider Business Practice Location Address
First Line	:	4636 N RAVENSWOOD AVE STE 101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4578
Country	:	US
Telephone Number	:	773-516-4146
Fax Number	:	773-961-7922

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	05/27/2026

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