Provider Demographics
NPI:1750714697
Name:OKONSKA, AGNIESZKA (PT)
Entity type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:OKONSKA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 COVE LN APT A
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3575
Mailing Address - Country:US
Mailing Address - Phone:847-873-6671
Mailing Address - Fax:847-759-1824
Practice Address - Street 1:5935 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1629
Practice Address - Country:US
Practice Address - Phone:773-685-0911
Practice Address - Fax:773-282-6241
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist