Provider Demographics
NPI:1972730786
Name:FABRICANTE, MARY ELAINE MABAYAG (PT, DPT)
Entity type:Individual
Prefix:MISS
First Name:MARY ELAINE
Middle Name:MABAYAG
Last Name:FABRICANTE
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 CLOVER HILL CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-7126
Mailing Address - Country:US
Mailing Address - Phone:773-474-0858
Mailing Address - Fax:
Practice Address - Street 1:401 W LAKE ST
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:IL
Practice Address - Zip Code:60164-2435
Practice Address - Country:US
Practice Address - Phone:708-223-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.014844225100000X
WI11184024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist