Healthcare Provider Details

I. General information

NPI: 1750714697
Provider Name (Legal Business Name): AGNIESZKA OKONSKA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5935 W MONTROSE AVE
CHICAGO IL
60634-1629
US

IV. Provider business mailing address

4110 COVE LN APT A
GLENVIEW IL
60025-3575
US

V. Phone/Fax

Practice location:
  • Phone: 773-685-0911
  • Fax: 773-282-6241
Mailing address:
  • Phone: 847-873-6671
  • Fax: 847-759-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070017087
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: