MEDICARE: MS. ELLEN B FRIEDMAN 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	070-002158	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01634229	OTHER	IL	BCBS PROVIDER #

General Provider Information

NPI Number	:	1528139862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN B FRIEDMAN P.T.

Provider Business Mailing Address
First Line	:	5400 N VIRGINIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3916
Country	:	US
Telephone Number	:	773-561-0797
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 N VIRGINIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3916
Country	:	US
Telephone Number	:	773-561-0797
Fax Number	:

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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