Provider Demographics
NPI:1336112218
Name:KAJTSA, ANGELA (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KAJTSA
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 1:1900 OGDEN AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4273
Mailing Address - Country:US
Mailing Address - Phone:630-978-6218
Mailing Address - Fax:
Practice Address - Street 1:728 E.VETERANS PKWY.
Practice Address - Street 2:SUITE 107
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1095
Practice Address - Country:US
Practice Address - Phone:630-978-6218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-010482208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
P31455Medicare UPIN