Provider Demographics
NPI:1336254077
Name:MAGGU, PREETI R (PT)
Entity Type:Individual
Prefix:MRS
First Name:PREETI
Middle Name:R
Last Name:MAGGU
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 1:407 READ ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3260
Mailing Address - Country:US
Mailing Address - Phone:630-910-8480
Mailing Address - Fax:630-910-8482
Practice Address - Street 1:7530 WOODWARD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3100
Practice Address - Country:US
Practice Address - Phone:630-910-8480
Practice Address - Fax:630-910-8482
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
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