Provider Demographics
NPI:1831566124
Name:PLATEK, MALGORZATA (LMT)
Entity type:Individual
Prefix:MRS
First Name:MALGORZATA
Middle Name:
Last Name:PLATEK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-2125
Mailing Address - Country:US
Mailing Address - Phone:630-606-7463
Mailing Address - Fax:
Practice Address - Street 1:615 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-2125
Practice Address - Country:US
Practice Address - Phone:630-606-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.001412225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist