Healthcare Provider Details

I. General information

NPI: 1740406172
Provider Name (Legal Business Name): JANINA KOJAK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4621 WINCHESTER AVE
LISLE IL
60532-1547
US

IV. Provider business mailing address

4621 WINCHESTER AVE
LISLE IL
60532-1547
US

V. Phone/Fax

Practice location:
  • Phone: 630-968-6370
  • Fax: 630-968-7718
Mailing address:
  • Phone: 630-968-6370
  • Fax: 630-968-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number70-006960
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: