Healthcare Provider Details

I. General information

NPI: 1396236139
Provider Name (Legal Business Name): MARY B SAXTON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY B CIPOLLA DPT

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N LA GRANGE RD
LA GRANGE PARK IL
60526
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 708-482-9320
  • Fax: 708-482-9760
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070023749
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: