Provider Demographics
NPI:1720085095
Name:CENIZA, PRETZEL A (PT)
Entity Type:Individual
Prefix:MRS
First Name:PRETZEL
Middle Name:A
Last Name:CENIZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PRETZEL
Other - Middle Name:
Other - Last Name:AMADORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:2562 W SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3897
Practice Address - Country:US
Practice Address - Phone:847-519-3485
Practice Address - Fax:847-519-3614
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02222753OtherBCBS
IL02222753OtherBCBS