=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245493691
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUCIE D CASIELLO MPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2008
-----------------------------------------------------
Last Update Date | 09/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4700 GILBERT AVE SUITE 43A
-----------------------------------------------------
City | WESTERN SPRINGS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60558-1753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-783-1044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 625 ENTERPRISE DR
-----------------------------------------------------
City | OAK BROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60523-8813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-590-1940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070-010483
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------