Healthcare Provider Details

I. General information

NPI: 1184300204
Provider Name (Legal Business Name): KATHERINE KOBESZKA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3819 N RIDGEWAY AVE
CHICAGO IL
60618-4013
US

IV. Provider business mailing address

3819 N RIDGEWAY AVE
CHICAGO IL
60618-4013
US

V. Phone/Fax

Practice location:
  • Phone: 419-957-8403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070027381
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: