MEDICARE: MANDIE MARTUZZO LPT

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	070-010880	IL

General Provider Information

NPI Number	:	1851428445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDIE MARTUZZO LPT

Provider Business Mailing Address
First Line	:	100 E IRVING PARK RD
Second Line	:	STE. 107
City	:	ROSELLE
State	:	IL
Zip	:	60172-2048
Country	:	US
Telephone Number	:	630-439-0009
Fax Number	:	630-439-0011

Provider Business Practice Location Address
First Line	:	2143 W WELLINGTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-8268
Country	:	US
Telephone Number	:	773-528-5400
Fax Number	:	773-528-0607

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	02/17/2009

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