Provider Demographics
NPI:1114451929
Name:MARIANO, LINFRED
Entity Type:Individual
Prefix:
First Name:LINFRED
Middle Name:
Last Name:MARIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W ENTERPRISE DR
Mailing Address - Street 2:APT 312
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-5888
Mailing Address - Country:US
Mailing Address - Phone:520-431-0415
Mailing Address - Fax:
Practice Address - Street 1:505 W ENTERPRISE DR
Practice Address - Street 2:APT 312
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-5888
Practice Address - Country:US
Practice Address - Phone:520-431-0415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005869225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant