Provider Demographics
NPI:1578717773
Name:GUILLEN, MARC (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 BRUMMEL ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3668
Mailing Address - Country:US
Mailing Address - Phone:773-599-3393
Mailing Address - Fax:773-453-7898
Practice Address - Street 1:2618 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7107
Practice Address - Country:US
Practice Address - Phone:773-599-3393
Practice Address - Fax:773-453-7898
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5802225100000X
WA60160970225100000X
IL070.019810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500605246Medicaid