Provider Demographics
NPI:1154067908
Name:WOLOWSKI, JACEK
Entity Type:Individual
Prefix:
First Name:JACEK
Middle Name:
Last Name:WOLOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 DEERFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2653
Mailing Address - Country:US
Mailing Address - Phone:847-520-9038
Mailing Address - Fax:
Practice Address - Street 1:1567 DEERFIELD PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2653
Practice Address - Country:US
Practice Address - Phone:847-520-9038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist