Healthcare Provider Details

I. General information

NPI: 1215217153
Provider Name (Legal Business Name): STEVE B. KALINOWSKI PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W LAKE ST
HANOVER PARK IL
60133-4302
US

IV. Provider business mailing address

140 BROOKSIDE DR
GLENDALE HEIGHTS IL
60139-1913
US

V. Phone/Fax

Practice location:
  • Phone: 630-556-2000
  • Fax:
Mailing address:
  • Phone: 630-653-1013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.005087
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: