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NPI Code Detail

MEDICARE: MANDY BREEN PTA

MEDICARE: MANDY BREEN PTA
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
1225200000XPhysical Therapy AssistantIL

General Provider Information

NPI Number : 1831230176
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDY BREEN PTA
Provider Business Mailing Address
First Line : 20 N MICHIGAN AVE
Second Line : STE 103
City : CHICAGO
State : IL
Zip : 60602-4811
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20 N MICHIGAN AVE
Second Line : SUITE 103
City : CHICAGO
State : IL
Zip : 60602-4811
Country : US
Telephone Number : 312-236-0660
Fax Number : 312-236-1219
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2007
Last Update Date : 07/11/2007

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