Provider Demographics
NPI:1477046910
Name:WASILEWSKI, TOMASZ ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:TOMASZ
Middle Name:ROBERT
Last Name:WASILEWSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 W PETERSON AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5723
Mailing Address - Country:US
Mailing Address - Phone:773-725-8809
Mailing Address - Fax:773-725-4202
Practice Address - Street 1:4747 W PETERSON AVE STE 105
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5723
Practice Address - Country:US
Practice Address - Phone:773-725-8809
Practice Address - Fax:773-725-4202
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-10
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty