Provider Demographics
NPI:1235561614
Name:KRUSZEWSKI, VICTORIA (PTA)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:KRUSZEWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 GALITZ ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4103
Mailing Address - Country:US
Mailing Address - Phone:847-431-8048
Mailing Address - Fax:
Practice Address - Street 1:5200 GALITZ ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4103
Practice Address - Country:US
Practice Address - Phone:847-431-8048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005279225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant