Healthcare Provider Details

I. General information

NPI: 1144271594
Provider Name (Legal Business Name): DOROTA M. LUKASIEWICZ P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: DOROTA SOBCZAK P.T.

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N WESTERN AVE
CHICAGO IL
60622-4777
US

IV. Provider business mailing address

925 N WESTERN AVE
CHICAGO IL
60622-4777
US

V. Phone/Fax

Practice location:
  • Phone: 773-227-5150
  • Fax: 773-227-6670
Mailing address:
  • Phone: 773-227-5150
  • Fax: 773-227-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: