Provider Demographics
NPI:1750654455
Name:MUDRONJA, DENISE ANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:ANNE
Last Name:MUDRONJA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:ANNE
Other - Last Name:GERVAIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5700 N CLARK ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4020
Mailing Address - Country:US
Mailing Address - Phone:513-479-9613
Mailing Address - Fax:
Practice Address - Street 1:5333 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7371
Practice Address - Country:US
Practice Address - Phone:773-997-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-12
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist