MEDICARE: DR. RAYMOND NICHOLAS DEGLI 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	PTL0013389	CO

General Provider Information

NPI Number	:	1962705657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND NICHOLAS DEGLI DPT

Provider Business Mailing Address
First Line	:	PO BOX 883299
Second Line	:	SUITE 2
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80488-3299
Country	:	US
Telephone Number	:	970-879-8026
Fax Number	:	970-879-8046

Provider Business Practice Location Address
First Line	:	211 N CLINTON ST
Second Line	:	SUITE 2
City	:	CHICAGO
State	:	IL
Zip	:	60661-1282
Country	:	US
Telephone Number	:	630-876-9186
Fax Number	:	630-876-9187

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

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	09/15/2016

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