Provider Demographics
NPI:1093983751
Name:LACIAK, IWONA (PT)
Entity Type:Individual
Prefix:
First Name:IWONA
Middle Name:
Last Name:LACIAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 ROSE CT
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-7404
Mailing Address - Country:US
Mailing Address - Phone:630-699-4839
Mailing Address - Fax:
Practice Address - Street 1:14330 S WILL COOK RD
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9211
Practice Address - Country:US
Practice Address - Phone:708-645-0288
Practice Address - Fax:708-349-7430
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist