Provider Demographics
NPI:1346608189
Name:KAPUSCIK, BARBARA (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:KAPUSCIK
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 1:2896 DARTMOUTH LN
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-1771
Mailing Address - Country:US
Mailing Address - Phone:630-337-6640
Mailing Address - Fax:
Practice Address - Street 1:2896 DARTMOUTH LN
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-1771
Practice Address - Country:US
Practice Address - Phone:630-337-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.005603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK12206053814OtherDRIVER'S LICENCE