MEDICARE: THORSTEIN DEGNES

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	070004633	IL

General Provider Information

NPI Number	:	1528469327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THORSTEIN DEGNES

Provider Business Mailing Address
First Line	:	3740 N HALSTED ST, APT 920
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5653
Country	:	US
Telephone Number	:	317-946-2835
Fax Number	:

Provider Business Practice Location Address
First Line	:	3740 N HALSTED ST APT 920
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5657
Country	:	US
Telephone Number	:	317-946-2835
Fax Number	:

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

Provider Enumeration Date	:	09/11/2014
Last Update Date	:	09/11/2014

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Directions to “ THORSTEIN DEGNES ” Practice Location

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