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NPI Code Detail

MEDICARE: MARY K MIXAN DPT

MEDICARE: MARY K MIXAN 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
1225100000XPhysical Therapist070-024795IL

General Provider Information

NPI Number : 1871140806
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY K MIXAN DPT
Provider Business Mailing Address
First Line : 600 OAKMONT LN STE 600C
Second Line :
City : WESTMONT
State : IL
Zip : 60559-5548
Country : US
Telephone Number : 630-575-1980
Fax Number : 630-928-5080
Provider Business Practice Location Address
First Line : 3922 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2926
Country : US
Telephone Number : 773-327-0040
Fax Number : 773-327-0040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2019
Last Update Date : 10/24/2024

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Directions to “ MARY K MIXAN DPT” Practice Location

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