Healthcare Provider Details

I. General information

NPI: 1093072373
Provider Name (Legal Business Name): KM PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5838 S HARLEM AVE
SUMMIT IL
60501-1407
US

IV. Provider business mailing address

2703 N DRAKE AVE
CHICAGO IL
60647-1234
US

V. Phone/Fax

Practice location:
  • Phone: 773-645-8039
  • Fax: 773-657-5377
Mailing address:
  • Phone: 224-203-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number070.014455
License Number StateIL

VIII. Authorized Official

Name: MARCIN CWIKLA
Title or Position: PRESIDENT
Credential:
Phone: 773-645-8039