MEDICARE: BEVERLY PHYSICAL THERAPY LTD

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	111NR0400X	Rehabilitation Chiropractor
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1528810421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY PHYSICAL THERAPY LTD

Provider Business Mailing Address
First Line	:	710 N DEARBORN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-5900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 W 95TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1001
Country	:	US
Telephone Number	:	773-288-8500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEFANIE SHAW
Credential	:
Telephone Number	:	312-437-1129

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	04/03/2024

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