Provider Demographics
NPI:1871682765
Name:REDLICKI, BEATA
Entity Type:Individual
Prefix:MRS
First Name:BEATA
Middle Name:
Last Name:REDLICKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BEATA
Other - Middle Name:
Other - Last Name:KYSIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:44 PARK VIEW LN
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8972
Mailing Address - Country:US
Mailing Address - Phone:847-726-2066
Mailing Address - Fax:
Practice Address - Street 1:41 E MAIN ST
Practice Address - Street 2:SUITE # 110
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3413
Practice Address - Country:US
Practice Address - Phone:847-726-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist