Provider Demographics
NPI:1063654572
Name:KOCEMBA, VIOLETTA MALGORZATA (PT)
Entity Type:Individual
Prefix:MRS
First Name:VIOLETTA
Middle Name:MALGORZATA
Last Name:KOCEMBA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:VIOLETTA
Other - Middle Name:MALGORZATA
Other - Last Name:ORZECHOWSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1362 ALMADEN LN
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5622
Mailing Address - Country:US
Mailing Address - Phone:184-754-8495
Mailing Address - Fax:
Practice Address - Street 1:3703 W LAKE AVE STE 200
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1266
Practice Address - Country:US
Practice Address - Phone:847-998-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.007547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist