Provider Demographics
NPI:1740378918
Name:MLYNARCZYK, YVONNE (PT)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:MLYNARCZYK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 LINCOLN AVE STE 105A
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1290
Mailing Address - Country:US
Mailing Address - Phone:331-223-9800
Mailing Address - Fax:773-337-9106
Practice Address - Street 1:4513 LINCOLN AVE STE 105A
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532
Practice Address - Country:US
Practice Address - Phone:331-223-9800
Practice Address - Fax:773-337-9106
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist