Provider Demographics
NPI:1487859252
Name:KOSTYRA-STRALL, AGNIESZKA D (PT)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:D
Last Name:KOSTYRA-STRALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AGNIESZKA
Other - Middle Name:D
Other - Last Name:KOSTYRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:909 E PALATINE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-5551
Mailing Address - Country:US
Mailing Address - Phone:847-776-1400
Mailing Address - Fax:847-776-1864
Practice Address - Street 1:909 E PALATINE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-5551
Practice Address - Country:US
Practice Address - Phone:847-776-1400
Practice Address - Fax:847-776-1864
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-010066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK38959Medicare PIN