Provider Demographics
NPI:1790401263
Name:OKSIUTA, EWA (PTA)
Entity Type:Individual
Prefix:
First Name:EWA
Middle Name:
Last Name:OKSIUTA
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 1:2750 COMMONS DR UNIT 302
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-7816
Mailing Address - Country:US
Mailing Address - Phone:773-251-9524
Mailing Address - Fax:
Practice Address - Street 1:1879 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1602
Practice Address - Country:US
Practice Address - Phone:224-543-6062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.007357225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant