Provider Demographics
NPI:1174647069
Name:BOYNEWICZ, KARA (PT)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:
Last Name:BOYNEWICZ
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 1:3721 N RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3524
Mailing Address - Country:US
Mailing Address - Phone:773-478-9245
Mailing Address - Fax:435-578-8231
Practice Address - Street 1:3721 N RICHMOND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3524
Practice Address - Country:US
Practice Address - Phone:773-478-9245
Practice Address - Fax:435-578-8231
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.012672225100000X
IL070012672252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency