Provider Demographics
NPI:1720416274
Name:MARCOTTE, ANGELA (DPT)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:
Last Name:MARCOTTE
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 1:600 BASIL RD
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1704
Mailing Address - Country:US
Mailing Address - Phone:224-288-8797
Mailing Address - Fax:
Practice Address - Street 1:600 BASIL RD
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044
Practice Address - Country:US
Practice Address - Phone:224-288-8797
Practice Address - Fax:847-574-5902
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-21
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 28548225100000X
NY047345225100000X
IL070.021243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist