Provider Demographics
NPI:1093841389
Name:FRONCZAK, KATHRYN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:FRONCZAK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11227 STONEBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1720
Mailing Address - Country:US
Mailing Address - Phone:847-370-5289
Mailing Address - Fax:
Practice Address - Street 1:8133 ARDREY KELL RD STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5723
Practice Address - Country:US
Practice Address - Phone:704-413-0968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700143802251P0200X
NCP174212251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1093841389Medicaid