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General NPI Number Information
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NPI Number | 1972730786
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Entity Type | Individual
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Provider Name | MARY ELAINE MABAYAG FABRICANTE PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 401 W LAKE ST
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City | NORTHLAKE
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State | IL
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Zip | 60164-2435
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Country | US
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Telephone | 708-223-0494
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Fax |
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Provider Business Mailing Address
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Address Line | 748 CLOVER HILL CT
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-7126
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Country | US
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Telephone | 773-474-0858
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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 | 070.014844
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11184024
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License Number State | WI
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