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NPI Code Detail

MEDICARE: ELIZABETH BLUDGEN MPT

MEDICARE: ELIZABETH BLUDGEN MPT
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 Therapist070008012IL

General Provider Information

NPI Number : 1972939593
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH BLUDGEN MPT
Provider Business Mailing Address
First Line : PO BOX 713260
Second Line :
City : CHICAGO
State : IL
Zip : 60677-0018
Country : US
Telephone Number : 630-469-9200
Fax Number :
Provider Business Practice Location Address
First Line : 12004 S ROUTE 59 UNIT 100
Second Line :
City : PLAINFIELD
State : IL
Zip : 60585-5108
Country : US
Telephone Number : 815-416-6652
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2013
Last Update Date : 05/25/2023

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