Provider Demographics
NPI:1669590816
Name:WLODARSKI THERAPY GROUP PC
Entity type:Organization
Organization Name:WLODARSKI THERAPY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PT
Authorized Official - Prefix:
Authorized Official - First Name:WIESLAW
Authorized Official - Middle Name:
Authorized Official - Last Name:WLODARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-777-9871
Mailing Address - Street 1:4005 N NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1428
Mailing Address - Country:US
Mailing Address - Phone:773-777-9871
Mailing Address - Fax:773-777-9872
Practice Address - Street 1:4005 N NASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1428
Practice Address - Country:US
Practice Address - Phone:773-777-9871
Practice Address - Fax:773-777-9872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070006747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL378050Medicare ID - Type Unspecified