Provider Demographics
NPI:1043002298
Name:KWAK, JUSTINE ANNA
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:ANNA
Last Name:KWAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14225 S 95TH AVE STE 453
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2266
Mailing Address - Country:US
Mailing Address - Phone:708-787-0952
Mailing Address - Fax:708-787-0958
Practice Address - Street 1:14225 S 95TH AVE STE 453
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2266
Practice Address - Country:US
Practice Address - Phone:708-787-0952
Practice Address - Fax:708-787-0958
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist