Provider Demographics
NPI:1699858902
Name:BACCI, MARY CATHERINE (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:BACCI
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 1:2632 ROSLYN CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1910
Mailing Address - Country:US
Mailing Address - Phone:847-432-1575
Mailing Address - Fax:847-432-2260
Practice Address - Street 1:1640 W ROOSEVELT RD
Practice Address - Street 2:MAIL CODE 726
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1316
Practice Address - Country:US
Practice Address - Phone:312-413-7786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
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