Provider Demographics
NPI:1841412749
Name:KOT, MARY LU (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LU
Last Name:KOT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:21 - 162ND PLACE
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409
Mailing Address - Country:US
Mailing Address - Phone:708-862-3423
Mailing Address - Fax:708-862-3423
Practice Address - Street 1:221 US HWY. 41
Practice Address - Street 2:SUITE G
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375
Practice Address - Country:US
Practice Address - Phone:219-322-2037
Practice Address - Fax:219-322-9787
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN05002036A2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics