Active NPI
Marilyn Brastad
- Physical Therapy Assistant
- McHenry, IL
National Provider Identifier
1124457601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- SAVE
- Practice address
- 3516 Waukegan Rd
McHenry, IL 60050-5732 - Phone
- (815) 271-5249
- NPI assigned
- Nov 5, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | SAVE | IL | Primary |
Addresses
Primary practice location
3516 Waukegan Rd
McHenry, IL 60050-5732
Mailing address
3516 Waukegan Rd
McHenry, IL 60050-5732
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SAVE | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383609600000",
"number": "1124457601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3516 WAUKEGAN RD",
"city": "MCHENRY",
"state": "IL",
"postal_code": "600505732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3516 WAUKEGAN RD",
"city": "MCHENRY",
"state": "IL",
"postal_code": "600505732",
"telephone_number": "815-271-5249"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRASTAD",
"first_name": "MARILYN",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-05",
"last_updated": "2013-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "SAVE",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McHenry, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.