MEDICARE: LUCIE D CASIELLO MPT

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
1	225100000X	Physical Therapist	070-010483	IL

General Provider Information

NPI Number	:	1245493691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIE D CASIELLO MPT

Provider Business Mailing Address
First Line	:	625 ENTERPRISE DR
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-8813
Country	:	US
Telephone Number	:	630-590-1940
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 GILBERT AVE
Second Line	:	SUITE 43A
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-1753
Country	:	US
Telephone Number	:	708-783-1044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	09/27/2016

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