Mary Vianelle Lichauco, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070.026346 Issued in IL

Practice address

9933 Lawler Ave Ste 105
Skokie, IL 60077-3753

Phone

(224) 278-1088

Fax

(847) 264-9088

NPI assigned

Dec 11, 2023

Last updated

Dec 11, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Residential Physical Therapy Services

  • Physical Medicine & Rehabilitation Physician
  • Skokie, IL
  • NPI 1770162992
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702252800000",
    "number": "1225805070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9933 LAWLER AVE STE 105",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600773753",
            "telephone_number": "224-278-1088",
            "fax_number": "847-264-9088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9933 LAWLER AVE STE 105",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600773753",
            "telephone_number": "224-278-1088",
            "fax_number": "847-264-9088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICHAUCO",
        "first_name": "MARY",
        "middle_name": "VIANELLE",
        "name_prefix": "Miss",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-11",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.026346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Skokie, IL
• Providers in Skokie, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.