Provider Demographics
NPI:1770629289
Name:SMIRNOW, SYLWIA LUCJA (PHYSICAL THERAPIST B)
Entity Type:Individual
Prefix:
First Name:SYLWIA
Middle Name:LUCJA
Last Name:SMIRNOW
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4N368 MAPLE STR
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60104
Mailing Address - Country:US
Mailing Address - Phone:630-290-3311
Mailing Address - Fax:630-694-1395
Practice Address - Street 1:535 S ELM STR
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143
Practice Address - Country:US
Practice Address - Phone:630-773-9416
Practice Address - Fax:630-773-6937
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist