Healthcare Provider Details

I. General information

NPI: 1861098774
Provider Name (Legal Business Name): MATEUSZ J ZAPOTOCZNY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 S STATE ST
CHICAGO IL
60605-2733
US

IV. Provider business mailing address

1103 S STATE ST
CHICAGO IL
60605-2733
US

V. Phone/Fax

Practice location:
  • Phone: 312-877-5101
  • Fax: 312-877-5906
Mailing address:
  • Phone: 312-877-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-025655
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: