Provider Demographics
NPI:1437542032
Name:NOGAR, MARY SUSAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SUSAN
Last Name:NOGAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E PEPPER TREE DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2740
Mailing Address - Country:US
Mailing Address - Phone:847-991-4533
Mailing Address - Fax:
Practice Address - Street 1:2171 W EXECUTIVE DR
Practice Address - Street 2:500
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-5625
Practice Address - Country:US
Practice Address - Phone:630-766-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.000365225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant