MEDICARE: ANGELA L KLISZ DPT

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	13635	WI
2	225100000X	Physical Therapist	070013810	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619980	OTHER	IL	BCBS OF IL
2	367885100	OTHER	IL	US DEPT OF LABOR
3	1623066	OTHER	IL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1336164177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA L KLISZ DPT

Provider Business Mailing Address
First Line	:	21075 SWENSON DR
Second Line	:	STE 600
City	:	WAUKESHA
State	:	WI
Zip	:	53186-2062
Country	:	US
Telephone Number	:	312-640-0329
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 STATION DR
Second Line	:	SUITE 250
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7978
Country	:	US
Telephone Number	:	815-356-1750
Fax Number	:	815-356-1755

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	06/07/2018

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Directions to “ ANGELA L KLISZ DPT” Practice Location

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