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NPI Code Detail

MEDICARE: MEREDITH P MANGUS DPT

MEDICARE: MEREDITH P MANGUS 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 Therapist070026974IL

General Provider Information

NPI Number : 1659099208
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEREDITH P MANGUS DPT
Provider Business Mailing Address
First Line : 2122 YORK RD STE 300
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-1925
Country : US
Telephone Number : 630-575-6200
Fax Number :
Provider Business Practice Location Address
First Line : 1644 E 53RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60615-4489
Country : US
Telephone Number : 773-241-6450
Fax Number : 773-241-6501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2022
Last Update Date : 01/20/2023

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Directions to “ MEREDITH P MANGUS DPT” Practice Location

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