Healthcare Provider Details

I. General information

NPI: 1518897024
Provider Name (Legal Business Name): MS. ELVINA MARSHAL MACWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9443 SUMAC RD UNIT E
DES PLAINES IL
60016-3885
US

IV. Provider business mailing address

9443 SUMAC RD
DES PLAINES IL
60016-3885
US

V. Phone/Fax

Practice location:
  • Phone: 331-401-4245
  • Fax: 331-401-4245
Mailing address:
  • Phone: 331-401-4245
  • Fax: 331-401-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055844
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: