Provider Demographics
NPI:1740406172
Name:KOJAK, JANINA (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANINA
Middle Name:
Last Name:KOJAK
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 1:4621 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1547
Mailing Address - Country:US
Mailing Address - Phone:630-968-6370
Mailing Address - Fax:630-968-7718
Practice Address - Street 1:4621 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1547
Practice Address - Country:US
Practice Address - Phone:630-968-6370
Practice Address - Fax:630-968-7718
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70-006960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002283037OtherBCBSIL