Provider Demographics
NPI:1215346846
Name:DREWITZ, MARIAN
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:DREWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:GUEST
Other - Last Name:DREWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:102 N MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:LINDENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61049-9518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 N MULFORD RD
Practice Address - Street 2:
Practice Address - City:LINDENWOOD
Practice Address - State:IL
Practice Address - Zip Code:61049-9518
Practice Address - Country:US
Practice Address - Phone:815-979-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.005017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist