Provider Demographics
NPI:1366627416
Name:ORCZYK, JERZY (PT)
Entity Type:Individual
Prefix:
First Name:JERZY
Middle Name:
Last Name:ORCZYK
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 1:3633 W LAKE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5801
Mailing Address - Country:US
Mailing Address - Phone:847-724-7600
Mailing Address - Fax:
Practice Address - Street 1:3633 W LAKE AVE STE 102
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5801
Practice Address - Country:US
Practice Address - Phone:847-724-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2024-03-16
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
IL364000697001Medicaid
IL364000697001Medicaid
IL209349Medicare PIN