MEDICARE: MICHAEL JAMES GIRZADAS

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	23614	MA
2	225100000X	Physical Therapist	PT5150	ME
3	225100000X	Physical Therapist	2017026662	MO

General Provider Information

NPI Number	:	1942787510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JAMES GIRZADAS

Provider Business Mailing Address
First Line	:	12243 S NAGLE AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1721
Country	:	US
Telephone Number	:	708-912-5196
Fax Number	:

Provider Business Practice Location Address
First Line	:	12243 S NAGLE AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1721
Country	:	US
Telephone Number	:	708-912-5196
Fax Number	:

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

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	07/25/2018

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