Provider Demographics
NPI:1245457969
Name:MUSIAL, MICHELLE M (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:MUSIAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:MUSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:15635 S 94TH AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4722
Practice Address - Country:US
Practice Address - Phone:708-460-8588
Practice Address - Fax:708-460-8788
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherBCBS IL GROUP NUMBER
IL567700OtherMEDICARE GROUP NUMBER
IL1623066OtherBCBS PROVIDER #
IL568080OtherMEDICARE GROUP NUMBER
ILDC7571OtherR.R. MEDICARE GROUP #
IL367885100OtherUS DEPT OF LABOR #
IL568150OtherMEDICARE GROUP NUMBER
ILCJ4383OtherR.R. MEDICARE GROUP #
IL367885100OtherUS DEPT OF LABOR #
IL568080OtherMEDICARE GROUP NUMBER
ILDC7571OtherR.R. MEDICARE GROUP #
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILR02219Medicare PIN