Provider Demographics
NPI:1508267782
Name:STACEY MARGUERITE LTD
Entity Type:Organization
Organization Name:STACEY MARGUERITE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC PHYSICAL THERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARGUERITE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:847-421-1076
Mailing Address - Street 1:51 PARK VIEW LN
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8968
Mailing Address - Country:US
Mailing Address - Phone:847-421-1076
Mailing Address - Fax:847-307-7955
Practice Address - Street 1:3330 OLD GLENVIEW RD
Practice Address - Street 2:SUITE 9
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2963
Practice Address - Country:US
Practice Address - Phone:847-421-1076
Practice Address - Fax:847-307-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070008992261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy