MEDICARE: DR. STACEY ANNE MARGUERITE 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
1	225100000X	Physical Therapist	070008992	IL

General Provider Information

NPI Number	:	1558505354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY ANNE MARGUERITE PT

Provider Business Mailing Address
First Line	:	1000 SKOKIE BLVD STE 150
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-1198
Country	:	US
Telephone Number	:	847-421-1076
Fax Number	:	847-307-7955

Provider Business Practice Location Address
First Line	:	1000 SKOKIE BLVD STE 150
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-1198
Country	:	US
Telephone Number	:	847-421-1076
Fax Number	:	847-307-7955

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

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	01/26/2026

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