Provider Demographics
NPI:1023171279
Name:MCAULEY, LUCY (PT)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:MCAULEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:LEATHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2934 CENTRAL ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-424-0130
Mailing Address - Fax:
Practice Address - Street 1:8700 DURAND AVE
Practice Address - Street 2:SUITE D
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177
Practice Address - Country:US
Practice Address - Phone:877-552-2996
Practice Address - Fax:866-245-8064
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist