Provider Demographics
NPI:1396595716
Name:MILANOWSKI, PAULINA VICTORIA
Entity type:Individual
Prefix:
First Name:PAULINA
Middle Name:VICTORIA
Last Name:MILANOWSKI
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 1:3450 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-7704
Mailing Address - Country:US
Mailing Address - Phone:618-931-3988
Mailing Address - Fax:
Practice Address - Street 1:3450 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-7704
Practice Address - Country:US
Practice Address - Phone:618-931-3988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070027854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist