Provider Demographics
NPI:1285253997
Name:MARK, CATHERINE JANE (DPT, PT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JANE
Last Name:MARK
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:JANE
Other - Last Name:STECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, PT
Mailing Address - Street 1:850 TOWNSHIP ROAD 750E
Mailing Address - Street 2:
Mailing Address - City:CARMAN
Mailing Address - State:IL
Mailing Address - Zip Code:61425-2042
Mailing Address - Country:US
Mailing Address - Phone:309-572-6281
Mailing Address - Fax:
Practice Address - Street 1:1000 W HARLEM AVE
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-1007
Practice Address - Country:US
Practice Address - Phone:309-734-1406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.025058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist