MEDICARE: MARK NUICO PT

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	070014806	IL
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1629204839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK NUICO PT

Provider Business Mailing Address
First Line	:	2718 N HAMPDEN CT APT 204
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-6258
Country	:	US
Telephone Number	:	312-752-6728
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2600
Country	:	US
Telephone Number	:	773-364-1723
Fax Number	:

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

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	03/14/2024

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Directions to “ MARK NUICO PT” Practice Location

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