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NPI Code Detail

MEDICARE: MARISA CLARE PT

MEDICARE: MARISA CLARE 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 Therapist070.026708IL

General Provider Information

NPI Number : 1801524046
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISA CLARE PT
Provider Business Mailing Address
First Line : 2555 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1768
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2555 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1768
Country : US
Telephone Number : 773-755-7566
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2022
Last Update Date : 07/27/2023

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Directions to “ MARISA CLARE PT” Practice Location

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