Provider Demographics
NPI:1790042109
Name:BACZYK OGLEDZINSKI, ALICJA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ALICJA
Middle Name:
Last Name:BACZYK OGLEDZINSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 W. DUNDEE RD.
Mailing Address - Street 2:SUITE 1S.
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-4894
Mailing Address - Country:US
Mailing Address - Phone:847-279-8008
Mailing Address - Fax:847-279-8006
Practice Address - Street 1:47 W. DUNDEE RD.
Practice Address - Street 2:SUITE 1S.
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-4894
Practice Address - Country:US
Practice Address - Phone:847-279-8008
Practice Address - Fax:847-279-8006
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160001720225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant