Healthcare Provider Details

I. General information

NPI: 1083962674
Provider Name (Legal Business Name): JUSTYNA KAMILA ZAWADZKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 N. CENTRAL AVE.
CHICAGO IL
60634-4426
US

IV. Provider business mailing address

3405 N. CENTRAL AVE.
CHICAGO IL
60634-4426
US

V. Phone/Fax

Practice location:
  • Phone: 773-685-0911
  • Fax:
Mailing address:
  • Phone: 773-685-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070019316
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: