Provider Demographics
NPI:1861657686
Name:BACZKOWSKI, HALINA (PTA)
Entity Type:Individual
Prefix:
First Name:HALINA
Middle Name:
Last Name:BACZKOWSKI
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 1:1245 POSTON PL
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-3064
Mailing Address - Country:US
Mailing Address - Phone:219-864-1733
Mailing Address - Fax:
Practice Address - Street 1:1245 POSTON PL
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-3064
Practice Address - Country:US
Practice Address - Phone:219-864-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003689A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant