Provider Demographics
NPI:1144236985
Name:LIEBREICH, MARGARET BRACCO (PT)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:BRACCO
Last Name:LIEBREICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:BRACCO
Other - Last Name:LIEBREICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:531 S RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1429
Mailing Address - Country:US
Mailing Address - Phone:708-848-3539
Mailing Address - Fax:708-383-3618
Practice Address - Street 1:531 S RIDGELAND AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1429
Practice Address - Country:US
Practice Address - Phone:708-848-3539
Practice Address - Fax:708-383-3618
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7593565OtherAETNA PROVIDER NUMBER
IL1633392OtherBLUE CROSS BLUE SHIELD