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General NPI Number Information
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NPI Number | 1508267782
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Entity Type | Organization
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Legal Business Name | STACEY MARGUERITE LTD
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 3330 OLD GLENVIEW RD SUITE 9
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City | WILMETTE
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State | IL
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Zip | 60091-2963
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Country | US
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Telephone | 847-421-1076
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Fax | 847-307-7955
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Provider Business Mailing Address
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Address Line | 51 PARK VIEW LN
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City | HAWTHORN WOODS
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State | IL
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Zip | 60047-8968
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Country | US
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Telephone | 847-421-1076
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Fax | 847-307-7955
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Authorized Official
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Title or Position | OWNER/PEDIATRIC PHYSICAL THERAPY
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Name | MRS. STACEY A MARGUERITE
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Credential | PT
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Telephone | 847-421-1076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 070008992
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License Number State | IL
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