Provider Demographics
NPI:1609982396
Name:NEILL, MARIANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:NEILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 THE LN
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3841
Mailing Address - Country:US
Mailing Address - Phone:630-920-1464
Mailing Address - Fax:
Practice Address - Street 1:7530 WOODWARD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3100
Practice Address - Country:US
Practice Address - Phone:630-910-8480
Practice Address - Fax:630-910-8482
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist