MEDICARE: CARRIE CICCIU-SINGER, PT INC.

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	2251P0200X	Pediatric Physical Therapist

General Provider Information

NPI Number	:	1720336951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARRIE CICCIU-SINGER, PT INC.

Provider Business Mailing Address
First Line	:	258 MARSEILLES ST
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-4147
Country	:	US
Telephone Number	:	847-702-1542
Fax Number	:	847-478-5311

Provider Business Practice Location Address
First Line	:	258 MARSEILLES ST
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-4147
Country	:	US
Telephone Number	:	847-702-1542
Fax Number	:	847-478-5311

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. CARRIE CICCIU-SINGER
Credential	:	PT
Telephone Number	:	847-702-1542

Provider Enumeration Date	:	08/20/2012
Last Update Date	:	08/20/2012

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