Provider Demographics
NPI:1790836658
Name:PADGURSKIS, PATRICIA M (DPT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:M
Last Name:PADGURSKIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:M
Other - Last Name:BLECKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11801 S WILL COOK RD
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1915
Mailing Address - Country:US
Mailing Address - Phone:773-910-9300
Mailing Address - Fax:
Practice Address - Street 1:11801 S WILL COOK RD
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-1915
Practice Address - Country:US
Practice Address - Phone:773-910-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013213225100000X
IL070-013213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3235Medicare UPIN