Healthcare Provider Details

I. General information

NPI: 1144236985
Provider Name (Legal Business Name): MARGARET BRACCO LIEBREICH P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEG BRACCO LIEBREICH P.T.

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 S RIDGELAND AVE
OAK PARK IL
60304-1429
US

IV. Provider business mailing address

531 S RIDGELAND AVE
OAK PARK IL
60304-1429
US

V. Phone/Fax

Practice location:
  • Phone: 708-848-3539
  • Fax: 708-383-3618
Mailing address:
  • Phone: 708-848-3539
  • Fax: 708-383-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: