Provider Demographics
NPI:1083071997
Name:KOSYCARZ, BEATA (PTA)
Entity Type:Individual
Prefix:MS
First Name:BEATA
Middle Name:
Last Name:KOSYCARZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5831 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2642
Mailing Address - Country:US
Mailing Address - Phone:773-775-8080
Mailing Address - Fax:773-775-9672
Practice Address - Street 1:5831 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2642
Practice Address - Country:US
Practice Address - Phone:773-775-8080
Practice Address - Fax:773-775-9672
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.001677225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant