Provider Demographics
NPI:1083894026
Name:CIEPIASZUK, TOM (LPTA)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:
Last Name:CIEPIASZUK
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E PALATINE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-1800
Mailing Address - Country:US
Mailing Address - Phone:847-459-4779
Mailing Address - Fax:847-459-5771
Practice Address - Street 1:15 E PALATINE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-1800
Practice Address - Country:US
Practice Address - Phone:847-459-4779
Practice Address - Fax:847-459-5771
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK06200Medicare UPIN
IL208912Medicare PIN