Healthcare Provider Details

I. General information

NPI: 1194364224
Provider Name (Legal Business Name): KAROLINA M NOWAK PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 BARRINGTON RD STE 101
HOFFMAN ESTATES IL
60169-5019
US

IV. Provider business mailing address

6N553 BAKER DR
ITASCA IL
60143-1933
US

V. Phone/Fax

Practice location:
  • Phone: 847-884-7771
  • Fax:
Mailing address:
  • Phone: 773-315-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: