MEDICARE: MS. TEKELA R SCOTT MPT

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	070012853	IL
2	2251X0800X	Orthopedic Physical Therapist	070012853	IL
3	2251S0007X	Sports Physical Therapist	070012853	IL
4	2251E1200X	Ergonomics Physical Therapist	070012853	IL
5	2251N0400X	Neurology Physical Therapist	070012853	IL

General Provider Information

NPI Number	:	1861540288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TEKELA R SCOTT MPT

Provider Business Mailing Address
First Line	:	1102 E 46TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-4435
Country	:	US
Telephone Number	:	708-359-9899
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 E 46TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-4435
Country	:	US
Telephone Number	:	708-359-9899
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/30/2013

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