MEDICARE: BOZENA SMOLECKA

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

General Provider Information

NPI Number	:	1689726291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOZENA SMOLECKA

Provider Business Mailing Address
First Line	:	8829 NIDA CT
Second Line	:
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-1262
Country	:	US
Telephone Number	:	708-430-5807
Fax Number	:

Provider Business Practice Location Address
First Line	:	5322 S ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4949
Country	:	US
Telephone Number	:	773-585-0430
Fax Number	:

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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