Healthcare Provider Details

I. General information

NPI: 1982376513
Provider Name (Legal Business Name): HAYLEY WREZINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26W171 ROOSEVELT RD
WHEATON IL
60187-6002
US

IV. Provider business mailing address

26W171 ROOSEVELT RD
WHEATON IL
60187-6002
US

V. Phone/Fax

Practice location:
  • Phone: 630-909-7150
  • Fax:
Mailing address:
  • Phone: 815-258-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.016085
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: