Provider Demographics
NPI:1134301468
Name:CZAJKOWSKI, KATHRYN GREEN (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GREEN
Last Name:CZAJKOWSKI
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 1:2445 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-4828
Mailing Address - Country:US
Mailing Address - Phone:630-513-2700
Mailing Address - Fax:630-513-2703
Practice Address - Street 1:2445 DEAN ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-4828
Practice Address - Country:US
Practice Address - Phone:630-513-2700
Practice Address - Fax:630-513-2703
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist