MEDICARE: BEATA NIKA

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	070.027140	IL

General Provider Information

NPI Number	:	1669182200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATA NIKA

Provider Business Mailing Address
First Line	:	2548 N PARKSIDE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1436 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-8123
Country	:	US
Telephone Number	:	312-651-6256
Fax Number	:

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

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/05/2022

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Directions to “ BEATA NIKA ” Practice Location

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