Provider Demographics
NPI:1891991162
Name:ELLYTHY, MARZOUK ABDELFATTAH (PT)
Entity Type:Individual
Prefix:DR
First Name:MARZOUK
Middle Name:ABDELFATTAH
Last Name:ELLYTHY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:100 E WALTON ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1448
Mailing Address - Country:US
Mailing Address - Phone:312-642-3963
Mailing Address - Fax:312-642-3966
Practice Address - Street 1:1365 WILEY RD
Practice Address - Street 2:SUITE 154
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4382
Practice Address - Country:US
Practice Address - Phone:224-653-8709
Practice Address - Fax:224-653-9452
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2016-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL070.021819225100000X
NY014435-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist