Provider Demographics
NPI:1710588264
Name:BE WELL PHYSICAL THERAPY AND WELLNESS INC.
Entity Type:Organization
Organization Name:BE WELL PHYSICAL THERAPY AND WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRZEMYSLAW
Authorized Official - Middle Name:
Authorized Official - Last Name:IICZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-230-1886
Mailing Address - Street 1:9504 PERTH CIR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-6275
Mailing Address - Country:US
Mailing Address - Phone:815-230-1886
Mailing Address - Fax:
Practice Address - Street 1:12509 W 159TH ST
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-7845
Practice Address - Country:US
Practice Address - Phone:815-230-1886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty