Provider Demographics
NPI:1598175937
Name:LHOTAK, MARY THERESE (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:THERESE
Last Name:LHOTAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:THERESE
Other - Last Name:LHOTAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2040 DUBLIN LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-2910
Mailing Address - Country:US
Mailing Address - Phone:734-883-5700
Mailing Address - Fax:
Practice Address - Street 1:1315 MACOM DR STE 103
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9360
Practice Address - Country:US
Practice Address - Phone:630-585-7337
Practice Address - Fax:630-585-7333
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0198822251N0400X, 2251X0800X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic