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NPI Code Detail

MEDICARE: STEPHANIE TATE DPT

MEDICARE: STEPHANIE TATE 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
1225100000XPhysical Therapist070.019460IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1070.019460OTHERILLICENSE

General Provider Information

NPI Number : 1861741084
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE TATE DPT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2223
Fax Number : 630-759-9510
Provider Business Practice Location Address
First Line : 300 W BUTTERFIELD RD
Second Line :
City : ELMHURST
State : IL
Zip : 60126-5017
Country : US
Telephone Number : 630-834-0478
Fax Number : 630-834-1677
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2012
Last Update Date : 08/08/2016

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