Provider Demographics
NPI:1932327814
Name:KOMUNIECKI, KRYSTYNA (PI)
Entity Type:Individual
Prefix:
First Name:KRYSTYNA
Middle Name:
Last Name:KOMUNIECKI
Suffix:
Gender:F
Credentials:PI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 BROADMOOR LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4301
Mailing Address - Country:US
Mailing Address - Phone:630-289-8737
Mailing Address - Fax:
Practice Address - Street 1:3401 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4426
Practice Address - Country:US
Practice Address - Phone:773-282-6230
Practice Address - Fax:773-282-6241
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
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