Provider Demographics
NPI:1972936615
Name:MAREK, JACLYN M (DPT)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:M
Last Name:MAREK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:M
Other - Last Name:HUDZINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:16750 80TH AVE STE B
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3174
Practice Address - Country:US
Practice Address - Phone:708-658-2780
Practice Address - Fax:708-658-2758
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-020060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist