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NPI Code Detail

MEDICARE: DEANNA V LIST

MEDICARE: DEANNA V LIST
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 Therapist070021865IL

General Provider Information

NPI Number : 1790157873
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA V LIST
Provider Business Mailing Address
First Line : 558 W 35TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-3532
Country : US
Telephone Number : 773-451-0200
Fax Number : 773-451-0700
Provider Business Practice Location Address
First Line : 558 W 35TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-3532
Country : US
Telephone Number : 773-451-0200
Fax Number : 773-451-0700
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2015
Last Update Date : 10/28/2015

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Directions to “ DEANNA V LIST ” Practice Location

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