Individual
BANSARI MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
2525 S MICHIGAN AVE, CHICAGO, IL 60616-2333
(312) 567-5550
Mailing address
PO BOX 8684, CHICAGO, IL 60680-8684
(630) 886-9674
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070-007131
IL
Other
Enumeration date
07/29/2012
Last updated
07/29/2012
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