Provider Demographics
NPI:1346478005
Name:SWOBODA, DOROTA MARIA (PT)
Entity Type:Individual
Prefix:
First Name:DOROTA
Middle Name:MARIA
Last Name:SWOBODA
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 1:4626 KOLZE AVE
Mailing Address - Street 2:
Mailing Address - City:SCHILLER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60176-1610
Mailing Address - Country:US
Mailing Address - Phone:847-217-1802
Mailing Address - Fax:
Practice Address - Street 1:4626 KOLZE AVE
Practice Address - Street 2:
Practice Address - City:SCHILLER PARK
Practice Address - State:IL
Practice Address - Zip Code:60176-1610
Practice Address - Country:US
Practice Address - Phone:847-217-1802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.011192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist