Provider Demographics
NPI:1912021031
Name:DOBBECK, MARY KAY (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY KAY
Middle Name:
Last Name:DOBBECK
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 1:3114 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-1066
Mailing Address - Country:US
Mailing Address - Phone:815-356-9510
Mailing Address - Fax:
Practice Address - Street 1:3114 OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-1066
Practice Address - Country:US
Practice Address - Phone:815-356-9510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
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