Provider Demographics
NPI:1578799151
Name:MACCANELLI, JOHN PETER (PT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:MACCANELLI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:5502 WASHINGTON AVE STE 500
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4094
Practice Address - Country:US
Practice Address - Phone:262-637-2470
Practice Address - Fax:262-637-2532
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI11220-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist