MEDICARE: MARIA ANALITIS PTA/FC

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	225200000X	Physical Therapy Assistant	160.003729	IL

General Provider Information

NPI Number	:	1942544754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ANALITIS PTA/FC

Provider Business Mailing Address
First Line	:	1833 FOUR LAKES AVE APT 4B
Second Line	:
City	:	LISLE
State	:	IL
Zip	:	60532-2918
Country	:	US
Telephone Number	:	708-567-7210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1833 FOUR LAKES AVE APT 4B
Second Line	:
City	:	LISLE
State	:	IL
Zip	:	60532-2918
Country	:	US
Telephone Number	:	708-567-7210
Fax Number	:

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

Provider Enumeration Date	:	11/16/2012
Last Update Date	:	11/16/2012

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Directions to “ MARIA ANALITIS PTA/FC” Practice Location

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