Provider Demographics
NPI:1255830709
Name:SZCZYGIEL, PRZEMYSLAW (RPT)
Entity Type:Individual
Prefix:MR
First Name:PRZEMYSLAW
Middle Name:
Last Name:SZCZYGIEL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:SZCZYGIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:109 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-2506
Mailing Address - Country:US
Mailing Address - Phone:847-259-5361
Mailing Address - Fax:
Practice Address - Street 1:2171 W EXECUTIVE DR STE 450
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-5610
Practice Address - Country:US
Practice Address - Phone:630-766-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070008750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist