MEDICARE: MADELINE SPORINA

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	:	1720816465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE SPORINA

Provider Business Mailing Address
First Line	:	2555 N CLARK ST APT 506
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1723
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1962 N BISSELL ST STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-0558
Country	:	US
Telephone Number	:	312-598-9991
Fax Number	:

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

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	07/24/2024

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