Provider Demographics
NPI:1497177430
Name:TIRKEL, EDITH (DPT)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:TIRKEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 N KEDZIE AVE
Mailing Address - Street 2:UNIT 506
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2845
Mailing Address - Country:US
Mailing Address - Phone:516-780-3379
Mailing Address - Fax:
Practice Address - Street 1:171 E 84TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2000
Practice Address - Country:US
Practice Address - Phone:212-327-0600
Practice Address - Fax:212-327-0776
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036769-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist