Provider Demographics
NPI:1639207947
Name:MOLEK, MARIA (PTA, PART C IEC)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:MOLEK
Suffix:
Gender:F
Credentials:PTA, PART C IEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4837 W ADDISON ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3531
Mailing Address - Country:US
Mailing Address - Phone:773-481-2390
Mailing Address - Fax:
Practice Address - Street 1:4837 W ADDISON ST APT 3B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3531
Practice Address - Country:US
Practice Address - Phone:847-724-7697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160-003677225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant