MEDICARE: FYSIOTHERAPIE PC

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	070013765	IL

General Provider Information

NPI Number	:	1598986077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FYSIOTHERAPIE PC

Provider Business Mailing Address
First Line	:	200 N JEFFERSON ST APT 2401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-1286
Country	:	US
Telephone Number	:	312-207-1774
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2915
Country	:	US
Telephone Number	:	773-342-8887
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SANJAY REDDY
Credential	:	PT
Telephone Number	:	312-207-1774

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	12/28/2007

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Directions to “FYSIOTHERAPIE PC ” Practice Location

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