MEDICARE: KELLY ALDRICH 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	070028296	IL

General Provider Information

NPI Number	:	1992545933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ALDRICH DPT

Provider Business Mailing Address
First Line	:	30728 RUNNING FOX TRL
Second Line	:
City	:	BURLINGTON
State	:	WI
Zip	:	53105-8966
Country	:	US
Telephone Number	:	262-210-4199
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3009
Country	:	US
Telephone Number	:	773-784-9406
Fax Number	:

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

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	05/28/2024

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