Provider Demographics
NPI:1063535201
Name:BARTELLI, MACKENZIE (DPT)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:BARTELLI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:1500 WAUKEGAN RD STE 250
Practice Address - Street 2:CARILLON SQUARE
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2165
Practice Address - Country:US
Practice Address - Phone:847-657-9445
Practice Address - Fax:847-657-9450
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist