Provider Demographics
NPI:1013478734
Name:STYRCZULA, KAROLINA E (PTA)
Entity Type:Individual
Prefix:
First Name:KAROLINA
Middle Name:E
Last Name:STYRCZULA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KAROLINA
Other - Middle Name:E
Other - Last Name:PIERWOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:4807 S LONG AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-1713
Mailing Address - Country:US
Mailing Address - Phone:630-440-5229
Mailing Address - Fax:
Practice Address - Street 1:4807 S LONG AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-1713
Practice Address - Country:US
Practice Address - Phone:630-440-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.007238225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant