Individual
CORI MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T
Contact information
Practice address
227 E ONTARIO ST, SUITE 201, CHICAGO, IL 60611-3385
(773) 417-6689
(312) 527-9202
Mailing address
1946 W NEWPORT AVE APT 3E, CHICAGO, IL 60657-1124
(773) 750-4560
(312) 527-9202
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070012671
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00082059
RAILROAD MEDICARE
IL
Enumeration date
01/04/2007
Last updated
02/25/2015
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