Provider Demographics
NPI:1467576009
Name:KASPER, MAUREEN CECILIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:CECILIA
Last Name:KASPER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 OAK ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2428
Mailing Address - Country:US
Mailing Address - Phone:708-424-9030
Mailing Address - Fax:773-779-7298
Practice Address - Street 1:10201 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1917
Practice Address - Country:US
Practice Address - Phone:773-779-7273
Practice Address - Fax:773-779-7298
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist