Provider Demographics
NPI:1083930861
Name:BARADZIEJ, MICHAL (LPT)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:
Last Name:BARADZIEJ
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6508 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2423
Mailing Address - Country:US
Mailing Address - Phone:773-313-3714
Mailing Address - Fax:
Practice Address - Street 1:6508 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2423
Practice Address - Country:US
Practice Address - Phone:773-313-3711
Practice Address - Fax:773-313-3714
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist