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NPI Code Detail

MEDICARE: THERESE J TULLY

MEDICARE: THERESE J TULLY
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 Therapist034680-1NY
2225100000XPhysical Therapist070021995IL

General Provider Information

NPI Number : 1982956041
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESE J TULLY
Provider Business Mailing Address
First Line : 625 ENTERPRISE DR
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-8813
Country : US
Telephone Number : 630-575-1940
Fax Number :
Provider Business Practice Location Address
First Line : 2400 N SHEFFIELD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-3936
Country : US
Telephone Number : 773-281-7991
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2012
Last Update Date : 05/18/2016

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