Provider Demographics
NPI:1124347745
Name:CALARCO, MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:CALARCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:FALCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5112 MUSEUM DR
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-7005
Mailing Address - Country:US
Mailing Address - Phone:708-952-8220
Mailing Address - Fax:708-423-5281
Practice Address - Street 1:5112 MUSEUM DR
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-7005
Practice Address - Country:US
Practice Address - Phone:708-952-8220
Practice Address - Fax:708-423-5281
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10610225100000X, 2251X0800X
IL070017038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
212193008Medicare UPIN