Provider Demographics
NPI:1336205889
Name:MICHALSKI, MAUREEN (MPT, DPT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MICHALSKI
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5329 MAIN ST APT 306
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5091
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 W PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-2869
Practice Address - Country:US
Practice Address - Phone:708-588-0833
Practice Address - Fax:708-588-0406
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070 014001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist