Provider Demographics
NPI:1740537075
Name:BRONKOWSKI, EMILY A (DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:BRONKOWSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:A
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6347 CERMAK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-4200
Mailing Address - Country:US
Mailing Address - Phone:708-749-2566
Mailing Address - Fax:708-749-2498
Practice Address - Street 1:6347 CERMAK RD
Practice Address - Street 2:SUITE A
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-4200
Practice Address - Country:US
Practice Address - Phone:708-749-2566
Practice Address - Fax:708-749-2498
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-019229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist