Provider Demographics
NPI:1003104142
Name:ADAMCZYK, AGNIESZKA (DPT)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:ADAMCZYK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AGNIESZKA
Other - Middle Name:
Other - Last Name:ADAMCZYK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2569 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5014
Mailing Address - Country:US
Mailing Address - Phone:847-809-8183
Mailing Address - Fax:
Practice Address - Street 1:2569 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-5014
Practice Address - Country:US
Practice Address - Phone:847-381-8812
Practice Address - Fax:847-381-6311
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216859187Medicare PIN