Provider Demographics
NPI:1790869220
Name:KACIUS, AMPARO VARELA (PT PHYSICAL THERAPIS)
Entity Type:Individual
Prefix:DR
First Name:AMPARO
Middle Name:VARELA
Last Name:KACIUS
Suffix:
Gender:F
Credentials:PT PHYSICAL THERAPIS
Other - Prefix:
Other - First Name:AMPARO
Other - Middle Name:
Other - Last Name:VARELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 NORTHFIELD SQ APT A
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3338
Mailing Address - Country:US
Mailing Address - Phone:847-826-2533
Mailing Address - Fax:847-441-5261
Practice Address - Street 1:1717 NORTHFIELD SQ APT A
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3338
Practice Address - Country:US
Practice Address - Phone:847-826-2533
Practice Address - Fax:847-441-5261
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010722225100000X
IN05004893A225100000X
NY0153651225100000X
CT005422225100000X
IL05004893A225100000X
IL0700100722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
212829Medicare ID - Type Unspecified