MEDICARE: MRS. CHANDI K. EDMONDS MPT, 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	070012346	IL
2	2251P0200X	Pediatric Physical Therapist	070012346	IL

General Provider Information

NPI Number	:	1740338847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHANDI K. EDMONDS MPT, DPT

Provider Business Mailing Address
First Line	:	221 E. CULLERTON
Second Line	:	UNIT 1120
City	:	CHICAGO
State	:	IL
Zip	:	60616-1498
Country	:	US
Telephone Number	:	312-593-3915
Fax Number	:	312-326-6009

Provider Business Practice Location Address
First Line	:	221 E. CULLERTON
Second Line	:	UNIT 1120
City	:	CHICAGO
State	:	IL
Zip	:	60616-1498
Country	:	US
Telephone Number	:	312-593-3915
Fax Number	:	312-326-6009

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	02/02/2011

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