Provider Demographics
NPI:1508091570
Name:CABASE, MARK IAN MADRONA (PT)
Entity Type:Individual
Prefix:
First Name:MARK IAN
Middle Name:MADRONA
Last Name:CABASE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26005 W MILESTONE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2331
Mailing Address - Country:US
Mailing Address - Phone:815-782-8871
Mailing Address - Fax:
Practice Address - Street 1:2203 PEMBRIDGE LN
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-7731
Practice Address - Country:US
Practice Address - Phone:815-409-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0149882251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics