Healthcare Provider Details

I. General information

NPI: 1518083674
Provider Name (Legal Business Name): SELENA ESTKA MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 W 81ST ST
JUSTICE IL
60458-1350
US

IV. Provider business mailing address

5830 S OAK PARK AVE
CHICAGO IL
60638-3232
US

V. Phone/Fax

Practice location:
  • Phone: 708-496-7744
  • Fax: 708-496-3382
Mailing address:
  • Phone: 773-229-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: