Basic Information
| Provider Information | |||||||||
| NPI: | 1770916447 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALONEY | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | DPT | ||||||||
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| OtherLastName: | SYSLO | ||||||||
| OtherFirstName: | LYNN | ||||||||
| OtherMiddleName: | M. | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 625 ENTERPRISE DR | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605238813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305751980 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1294 S ROUTE 12 | ||||||||
| Address2: | |||||||||
| City: | FOX LAKE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600201950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479739440 | ||||||||
| FaxNumber: | 8479739442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2013 | ||||||||
| LastUpdateDate: | 04/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070020034 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.