Healthcare Provider Details

I. General information

NPI: 1104739739
Provider Name (Legal Business Name): ELISE KRATKOCZKI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 PINGREE RD STE 209
CRYSTAL LAKE IL
60014-1727
US

IV. Provider business mailing address

55 S VAIL AVE APT 1409
ARLINGTON HEIGHTS IL
60005-1876
US

V. Phone/Fax

Practice location:
  • Phone: 847-458-8890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number070.040793
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: