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NPI Code Detail

MEDICARE: MS. ANGELA WILSON PENNISI PT

MEDICARE: MS. ANGELA WILSON PENNISI PT
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 Therapist070-011327IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1070-011327OTHERILSTATE LICENSE

General Provider Information

NPI Number : 1881673671
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANGELA WILSON PENNISI PT
Provider Business Mailing Address
First Line : 2929 N SOUTHPORT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6945
Country : US
Telephone Number : 773-665-9950
Fax Number : 773-665-9947
Provider Business Practice Location Address
First Line : 2929 N SOUTHPORT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6945
Country : US
Telephone Number : 773-665-9950
Fax Number : 773-665-9947
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 10/30/2007

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