MEDICARE: KATHRYN GREEN CZAJKOWSKI P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		IL

General Provider Information

NPI Number	:	1134301468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN GREEN CZAJKOWSKI P.T.

Provider Business Mailing Address
First Line	:	2445 DEAN ST
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60175-4828
Country	:	US
Telephone Number	:	630-513-2700
Fax Number	:	630-513-2703

Provider Business Practice Location Address
First Line	:	2445 DEAN ST
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60175-4828
Country	:	US
Telephone Number	:	630-513-2700
Fax Number	:	630-513-2703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	11/28/2007

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