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NPI Code Detail

MEDICARE: BOGDAN MATUSZYK P.T.

MEDICARE: BOGDAN MATUSZYK 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
1225100000XPhysical Therapist070007532IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1070007532OTHERILLICENSE NUMBER

General Provider Information

NPI Number : 1417276171
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOGDAN MATUSZYK P.T.
Provider Business Mailing Address
First Line : 736 W 35TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-4484
Country : US
Telephone Number : 773-247-2131
Fax Number :
Provider Business Practice Location Address
First Line : 736 W 35TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-4484
Country : US
Telephone Number : 773-247-2131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2010
Last Update Date : 05/20/2010

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