Provider Demographics
NPI:1699884346
Name:CICCIU-SINGER, CARRIE NICOLE (PT)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:NICOLE
Last Name:CICCIU-SINGER
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 1:258 E MARSEILLES ST
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-4147
Mailing Address - Country:US
Mailing Address - Phone:847-702-1542
Mailing Address - Fax:847-478-5311
Practice Address - Street 1:10 W PHILLIP RD STE 103
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1730
Practice Address - Country:US
Practice Address - Phone:847-702-1542
Practice Address - Fax:847-702-1542
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-009001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001625625OtherBLUE CROSS/BLUE SHIELD