Provider Demographics
NPI:1073051017
Name:COUNTER FORCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:COUNTER FORCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KONRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCZWARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-234-1760
Mailing Address - Street 1:340 E NORTH WATER
Mailing Address - Street 2:APARTMENT 3602
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:773-510-4312
Mailing Address - Fax:
Practice Address - Street 1:1115 W ARMITAGE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-234-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.022449261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy