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NPI Code Detail

MEDICARE: SOUTH CHICAGO PHYSICIAL MEDICINE

MEDICARE: SOUTH CHICAGO PHYSICIAL MEDICINE
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 Therapist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1F400120638OTHERILPTAN/MEDICARE

General Provider Information

NPI Number : 1902210008
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH CHICAGO PHYSICIAL MEDICINE
Provider Business Mailing Address
First Line : 11003 S KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2221
Country : US
Telephone Number : 773-350-1763
Fax Number :
Provider Business Practice Location Address
First Line : 11003 S KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2221
Country : US
Telephone Number : 773-350-1763
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. THOMAS P TOULIOS
Credential : DC
Telephone Number : 773-350-1763
Provider Enumeration Date : 06/17/2014
Last Update Date : 06/17/2014

Similar Medicare Providers

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Directions to “SOUTH CHICAGO PHYSICIAL MEDICINE ” Practice Location

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