=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730511460
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK ANTHONY LAGO PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2013
-----------------------------------------------------
Last Update Date | 06/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5601 W MONEE MANHATTAN RD STE 115
-----------------------------------------------------
City | MONEE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60449-8866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-314-7761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2122 YORK RD STE 300
-----------------------------------------------------
City | OAK BROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60523-1925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-575-6200
-----------------------------------------------------
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 | 070.019839
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------