Healthcare Provider Details

I. General information

NPI: 1043005655
Provider Name (Legal Business Name): PIOTR WOJNOWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 RIVER FRONT DR
MOUNT PROSPECT IL
60056-1993
US

IV. Provider business mailing address

214 RIVER FRONT DR
MOUNT PROSPECT IL
60056-1993
US

V. Phone/Fax

Practice location:
  • Phone: 773-865-7165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: