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General NPI Number Information
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NPI Number | 1205030616
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Entity Type | Individual
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Provider Name | MARIANNE BERNARDO BAGACINA PT
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Gender | Female
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 1330 W ARGYLE ST UNIT 1-E
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City | CHICAGO
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State | IL
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Zip | 60640-4713
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Country | US
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Telephone | 773-575-3399
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 W ARGYLE ST. UNIT 1-E
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City | CHICAGO
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State | IL
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Zip | 60640
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Country | US
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Telephone | 773-575-3399
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070015341
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License Number State | IL
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