Provider Demographics
NPI:1326064056
Name:PATELSKI, CHARLYNN MARIE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CHARLYNN
Middle Name:MARIE
Last Name:PATELSKI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 S CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5181
Mailing Address - Country:US
Mailing Address - Phone:847-825-4217
Mailing Address - Fax:847-318-7145
Practice Address - Street 1:1229 S CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5181
Practice Address - Country:US
Practice Address - Phone:847-825-4217
Practice Address - Fax:847-318-7145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031602233OtherBLUE CROSS BLUE SHIELD