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NPI Code Detail

MEDICARE: AVERY WARNER DPT, ATC

MEDICARE: AVERY WARNER DPT, ATC
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 Therapist070028702IL

General Provider Information

NPI Number : 1669290748
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY WARNER DPT, ATC
Provider Business Mailing Address
First Line : 3130 N LAKE SHORE DR APT 1312
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4920
Country : US
Telephone Number : 540-840-5229
Fax Number :
Provider Business Practice Location Address
First Line : 10 S CLINTON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60661-3400
Country : US
Telephone Number : 312-234-9958
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2024
Last Update Date : 09/28/2024

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