MEDICARE: GRACIELA PEREZ

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	261QP2000X	Physical Therapy Clinic/Center	160.005386	IL

General Provider Information

NPI Number	:	1992037691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACIELA PEREZ

Provider Business Mailing Address
First Line	:	6249 W 127TH ST
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2306
Country	:	US
Telephone Number	:	773-822-3628
Fax Number	:

Provider Business Practice Location Address
First Line	:	6249 W 127TH ST
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2306
Country	:	US
Telephone Number	:	773-822-3628
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REHAB
Name	:	FRANK CZUBA
Credential	:
Telephone Number	:	708-233-5116

Provider Enumeration Date	:	02/04/2010
Last Update Date	:	02/04/2010

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