Basic Information
| Provider Information | |||||||||
| NPI: | 1568002384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUGHES | ||||||||
| FirstName: | MARIZ | ||||||||
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| Credential: | BS PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | MORTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615501320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096488813 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 N CUMMINGS LN | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615719267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098862305 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2020 | ||||||||
| LastUpdateDate: | 01/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070017459 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.