Provider Demographics
NPI:1710937438
Name:INMAN, MARZENA M (DPT)
Entity Type:Individual
Prefix:
First Name:MARZENA
Middle Name:M
Last Name:INMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VILLAGE GRN STE 210
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3094
Mailing Address - Country:US
Mailing Address - Phone:847-634-2317
Mailing Address - Fax:
Practice Address - Street 1:100 VILLAGE GRN STE 210
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3094
Practice Address - Country:US
Practice Address - Phone:847-634-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK04270Medicare ID - Type Unspecified