MEDICARE: CENTER OF BALANCE, 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

General Provider Information

NPI Number	:	1659319697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER OF BALANCE, PC

Provider Business Mailing Address
First Line	:	1622 W SUNNYSIDE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5908
Country	:	US
Telephone Number	:	773-594-0225
Fax Number	:	773-439-2479

Provider Business Practice Location Address
First Line	:	1622 W SUNNYSIDE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5908
Country	:	US
Telephone Number	:	773-259-7180
Fax Number	:	773-439-2479

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARGARET NAULTY
Credential	:	PT
Telephone Number	:	773-259-7180

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	12/17/2014

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