MEDICARE: ALEXANDRIA KATSIRIS PT, 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
1	225100000X	Physical Therapist	070020943	IL

General Provider Information

NPI Number	:	1942601968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRIA KATSIRIS PT, DPT

Provider Business Mailing Address
First Line	:	1563 N. HOYNE AVENUE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1563 N HOYNE AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-1861
Country	:	US
Telephone Number	:	309-696-5975
Fax Number	:

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

Provider Enumeration Date	:	09/09/2014
Last Update Date	:	06/01/2017

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