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NPI Code Detail

MEDICARE: KATHRYN MEDINA DPT

MEDICARE: KATHRYN MEDINA 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
1225100000XPhysical Therapist070016481IL

General Provider Information

NPI Number : 1598094245
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN MEDINA DPT
Provider Business Mailing Address
First Line : 852 MADISON ST
Second Line :
City : OAK PARK
State : IL
Zip : 60302-4441
Country : US
Telephone Number : 708-445-3965
Fax Number : 708-445-1355
Provider Business Practice Location Address
First Line : 852 MADISON ST
Second Line :
City : OAK PARK
State : IL
Zip : 60302-4441
Country : US
Telephone Number : 708-445-3965
Fax Number : 708-445-1355
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2009
Last Update Date : 11/28/2016

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Directions to “ KATHRYN MEDINA DPT” Practice Location

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