| Doctor Name: | BRENT D MACK |
| NPI Number: | 1306938493 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 070-012918 |
| Business Practice Address: | 4334 Fox Valley Center Dr Suite C Aurora, IL - 605047945 |
| Business Phone Number: | 6302367544 |
| Business Fax Number: | 6302367574 |
| Mailing Address: | 25731 Meadowland Cir, PLAINFIELD |
| State: | IL |
| Postal Code: | 605852830 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/28/2006 |
| NPI Last Update Date: | 02/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 070-012918 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |