Provider Demographics
NPI:1669083879
Name:WAKSMANSKI, JANETTE DONNA (PTA)
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:DONNA
Last Name:WAKSMANSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 SHOLER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-1062
Mailing Address - Country:US
Mailing Address - Phone:773-372-5190
Mailing Address - Fax:
Practice Address - Street 1:7125 SHOLER AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1062
Practice Address - Country:US
Practice Address - Phone:773-372-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.008570225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant