Provider Demographics
NPI:1073005153
Name:MROCZENSKI, JACEY J (DPT)
Entity Type:Individual
Prefix:
First Name:JACEY
Middle Name:J
Last Name:MROCZENSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JACEY
Other - Middle Name:J
Other - Last Name:GEORGIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:1231 S ROCHESTER ST STE 210
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9032
Practice Address - Country:US
Practice Address - Phone:262-710-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14215-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist