Healthcare Provider Details

I. General information

NPI: 1801921994
Provider Name (Legal Business Name): MARY THERESE SEROCZYNSKI P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 E FAWN LN
PALATINE IL
60074-2361
US

IV. Provider business mailing address

478 E FAWN LN
PALATINE IL
60074-2361
US

V. Phone/Fax

Practice location:
  • Phone: 773-875-4814
  • Fax:
Mailing address:
  • Phone: 773-875-4814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070006578
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number070006578
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: