Provider Demographics
NPI:1598175473
Name:PRO BODY WELLNESS INC
Entity Type:Organization
Organization Name:PRO BODY WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MALGORZATA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORYNCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:847-899-1810
Mailing Address - Street 1:6724 W ALBION AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4470
Mailing Address - Country:US
Mailing Address - Phone:847-899-1810
Mailing Address - Fax:
Practice Address - Street 1:7900 N MILWAUKEE AVE
Practice Address - Street 2:SUITE#2-29
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3159
Practice Address - Country:US
Practice Address - Phone:847-899-1810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007940320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities