MEDICARE: ZUZANA KOTALOVA

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	225200000X	Physical Therapy Assistant	160.008722	IL

General Provider Information

NPI Number	:	1174136022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZUZANA KOTALOVA

Provider Business Mailing Address
First Line	:	1504 S FAIRFIELD AVE APT 26C
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-4664
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7421 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2139
Country	:	US
Telephone Number	:	773-814-3678
Fax Number	:

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

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	08/28/2020

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Directions to “ ZUZANA KOTALOVA ” Practice Location

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