MEDICARE: KELLY M MAYHEW DPT

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	070.025736	IL

General Provider Information

NPI Number	:	1538919113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY M MAYHEW DPT

Provider Business Mailing Address
First Line	:	2324 W SHAKESPEARE AVE APT 1R
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3281
Country	:	US
Telephone Number	:	937-657-8852
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 W SHAKESPEARE AVE APT 1R
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3281
Country	:	US
Telephone Number	:	937-657-8852
Fax Number	:

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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Directions to “ KELLY M MAYHEW DPT” Practice Location

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