Healthcare Provider Details

I. General information

NPI: 1932370764
Provider Name (Legal Business Name): SLAWOMIR ADAM KOWALCZYK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

IV. Provider business mailing address

730 45TH ST
MUNSTER IN
46321-2818
US

V. Phone/Fax

Practice location:
  • Phone: 630-575-6250
  • Fax:
Mailing address:
  • Phone: 630-575-6250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05004352A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: