MEDICARE: KERRY MICHELLE HUGHES 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	225100000X	Physical Therapist	070.015947	IL

General Provider Information

NPI Number	:	1497005235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY MICHELLE HUGHES PT

Provider Business Mailing Address
First Line	:	CALIFORNIA AVENUE AT 15TH STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1797
Country	:	US
Telephone Number	:	773-257-5628
Fax Number	:	773-257-6327

Provider Business Practice Location Address
First Line	:	CALIFORNIA AVENUE AT 15TH STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1797
Country	:	US
Telephone Number	:	773-257-5628
Fax Number	:	773-257-6327

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

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	09/19/2012

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