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NPI Code Detail

MEDICARE: MARK PHILLIP PASTRICK PT

MEDICARE: MARK PHILLIP PASTRICK PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070.006519IL

General Provider Information

NPI Number : 1053078758
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK PHILLIP PASTRICK PT
Provider Business Mailing Address
First Line : 15430 WEST AVE
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-4661
Country : US
Telephone Number : 708-923-5050
Fax Number : 708-226-2528
Provider Business Practice Location Address
First Line : 15430 WEST AVE
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-4661
Country : US
Telephone Number : 708-923-5050
Fax Number : 708-226-2528
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2021
Last Update Date : 11/17/2021

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