MEDICARE: REBECCA ANN QUINONES PT, 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
1	225100000X	Physical Therapist	70015834	IL

General Provider Information

NPI Number	:	1699974857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ANN QUINONES PT, DPT

Provider Business Mailing Address
First Line	:	225 E CHICAGO AVE
Second Line	:	BOX 147
City	:	CHICAGO
State	:	IL
Zip	:	60611-2991
Country	:	US
Telephone Number	:	312-227-6640
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2730
Country	:	US
Telephone Number	:	312-227-6640
Fax Number	:

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	04/19/2013

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