Healthcare Provider Details

I. General information

NPI: 1699884346
Provider Name (Legal Business Name): CARRIE NICOLE CICCIU-SINGER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W PHILLIP RD STE 103
VERNON HILLS IL
60061-1730
US

IV. Provider business mailing address

258 E MARSEILLES ST
VERNON HILLS IL
60061-4147
US

V. Phone/Fax

Practice location:
  • Phone: 847-702-1542
  • Fax: 847-702-1542
Mailing address:
  • Phone: 847-702-1542
  • Fax: 847-478-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-009001
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: