Healthcare Provider Details

I. General information

NPI: 1255830709
Provider Name (Legal Business Name): PRZEMYSLAW SZCZYGIEL RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PETER SZCZYGIEL RPT

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 W EXECUTIVE DR STE 450
ADDISON IL
60101-5610
US

IV. Provider business mailing address

109 BROOK RD
PROSPECT HTS IL
60070-2506
US

V. Phone/Fax

Practice location:
  • Phone: 630-766-0505
  • Fax:
Mailing address:
  • Phone: 847-259-5361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070008750
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: