MEDICARE: KERI GILLMORE VIETTI PT, MS

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	070-014404	IL

General Provider Information

NPI Number	:	1992856462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERI GILLMORE VIETTI PT, MS

Provider Business Mailing Address
First Line	:	6725 N KEDVALE AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-3511
Country	:	US
Telephone Number	:	773-203-5408
Fax Number	:	773-305-7730

Provider Business Practice Location Address
First Line	:	6725 N KEDVALE AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-3511
Country	:	US
Telephone Number	:	773-203-5408
Fax Number	:	773-305-7730

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

Provider Enumeration Date	:	01/13/2007
Last Update Date	:	06/14/2013

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