Provider Demographics
NPI:1245493691
Name:CASIELLO, LUCIE D (MPT)
Entity type:Individual
Prefix:
First Name:LUCIE
Middle Name:D
Last Name:CASIELLO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LUCIE
Other - Middle Name:D
Other - Last Name:DOBROVOLNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-590-1940
Mailing Address - Fax:
Practice Address - Street 1:4700 GILBERT AVE
Practice Address - Street 2:SUITE 43A
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1753
Practice Address - Country:US
Practice Address - Phone:708-783-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-010483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK52807Medicare PIN