Provider Demographics
NPI:1912542317
Name:HUSAIN, MARIAM (PT)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:HUSAIN
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 1:1830 MIDDLETON AVE
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1536
Mailing Address - Country:US
Mailing Address - Phone:630-251-4045
Mailing Address - Fax:
Practice Address - Street 1:1751 S NAPERVILLE RD STE 107
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5896
Practice Address - Country:US
Practice Address - Phone:630-682-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-10
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.024444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist