MEDICARE: KATARZYNA ANNA PORYS

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	070022003	IL

General Provider Information

NPI Number	:	1649779596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATARZYNA ANNA PORYS

Provider Business Mailing Address
First Line	:	5118 S NORMANDY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-1226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5118 S NORMANDY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-1226
Country	:	US
Telephone Number	:	773-610-3220
Fax Number	:

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

Provider Enumeration Date	:	02/06/2018
Last Update Date	:	02/06/2018

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