Provider Demographics
NPI:1336579440
Name:MCNALLY, MARY (DPT)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:REARDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:1145 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1529
Practice Address - Country:US
Practice Address - Phone:708-386-2086
Practice Address - Fax:708-386-3028
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist