Provider Demographics
NPI:1134316516
Name:ADU, MARIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:ADU
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 PRIMROSE CT APT 202
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-5162
Mailing Address - Country:US
Mailing Address - Phone:970-314-5386
Mailing Address - Fax:
Practice Address - Street 1:5400 W 87TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2913
Practice Address - Country:US
Practice Address - Phone:708-423-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist