Healthcare Provider Details

I. General information

NPI: 1134728918
Provider Name (Legal Business Name): BARBARA KOTULA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S RAND RD
LAKE ZURICH IL
60047-2450
US

IV. Provider business mailing address

23720 W HEARTHSIDE DR
DEER PARK IL
60010-9717
US

V. Phone/Fax

Practice location:
  • Phone: 847-726-1200
  • Fax:
Mailing address:
  • Phone: 773-931-9123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: