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NPI Code Detail

MEDICARE: TRISTAN SPRINGER DPT

MEDICARE: TRISTAN SPRINGER 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
1225100000XPhysical Therapist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00931638OTHERILMEDICARE RAILROAD

General Provider Information

NPI Number : 1952617862
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRISTAN SPRINGER DPT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2223
Fax Number :
Provider Business Practice Location Address
First Line : 2562 W SCHAUMBURG RD
Second Line :
City : SCHAUMBURG
State : IL
Zip : 60194-3897
Country : US
Telephone Number : 847-519-3485
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2010
Last Update Date : 01/07/2014

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