Provider Demographics
NPI:1043624323
Name:WRZOSEK, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:WRZOSEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 N CLARK ST
Mailing Address - Street 2:SUTE 24
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3853
Mailing Address - Country:US
Mailing Address - Phone:847-573-0051
Mailing Address - Fax:847-573-0345
Practice Address - Street 1:555 E TOWNLINE RD
Practice Address - Street 2:SUTE 24
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1552
Practice Address - Country:US
Practice Address - Phone:847-573-0051
Practice Address - Fax:847-573-0345
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist