MEDICARE: MARC GUILLEN PT, DPT

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	5802	OR
2	225100000X	Physical Therapist	60160970	WA
3	225100000X	Physical Therapist	070.019810	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578717773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC GUILLEN PT, DPT

Provider Business Mailing Address
First Line	:	4435 BRUMMEL ST
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-3668
Country	:	US
Telephone Number	:	773-599-3393
Fax Number	:	773-453-7898

Provider Business Practice Location Address
First Line	:	2618 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7107
Country	:	US
Telephone Number	:	773-599-3393
Fax Number	:	773-453-7898

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

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	05/23/2023

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Directions to “ MARC GUILLEN PT, DPT” Practice Location

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