Provider Demographics
NPI:1578850632
Name:TOLEMY, MAUREEN ANNE (PT, ATC)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ANNE
Last Name:TOLEMY
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WEST LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101
Mailing Address - Country:US
Mailing Address - Phone:708-296-2800
Mailing Address - Fax:
Practice Address - Street 1:500 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2307
Practice Address - Country:US
Practice Address - Phone:630-607-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960031062255A2300X
IL070020988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL096003106OtherILLINOIS LICENSE FOR ATHLETIC TRAINING
IL070020988OtherILLINOIS LICENSE FOR PHYSICAL THERAPY
IL096003106OtherILLINOIS LICENSE FOR ATHLETIC TRAINING