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NPI Code Detail

MEDICARE: TIARA LIZETH PIENKOS PT

MEDICARE: TIARA LIZETH PIENKOS 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
1225100000XPhysical Therapist070018582IL

General Provider Information

NPI Number : 1558647719
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIARA LIZETH PIENKOS PT
Provider Business Mailing Address
First Line : 1409 W CARROLL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1105
Country : US
Telephone Number : 312-733-0883
Fax Number :
Provider Business Practice Location Address
First Line : 1409 W CARROLL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60607-1105
Country : US
Telephone Number : 312-733-0883
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2011
Last Update Date : 01/11/2019

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