Healthcare Provider Details

I. General information

NPI: 1285806596
Provider Name (Legal Business Name): JAMES D WNEK JR. PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 N CICERO AVE SUITE 100
CHICAGO IL
60641-1651
US

IV. Provider business mailing address

10100 FOREST HILLS RD
MACHESNEY PARK IL
61115-8234
US

V. Phone/Fax

Practice location:
  • Phone: 773-794-1000
  • Fax: 773-794-9986
Mailing address:
  • Phone: 815-713-2600
  • Fax: 815-654-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: