Provider Demographics
NPI:1386974806
Name:MCGURK-MENSAH, BETSY ANN (PT, MED)
Entity type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:ANN
Last Name:MCGURK-MENSAH
Suffix:
Gender:F
Credentials:PT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 S WOODLAWN AVE
Mailing Address - Street 2:HOUSE A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4721 S WOODLAWN AVE
Practice Address - Street 2:HOUSE A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-1900
Practice Address - Country:US
Practice Address - Phone:773-268-4457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.005677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist