Healthcare Provider Details

I. General information

NPI: 1740537455
Provider Name (Legal Business Name): LINDA M KRAKORA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA M SENKOWKSI

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N MILWAUKEE ST
WATERFORD WI
53185-4432
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 262-514-2700
  • Fax: 262-514-3003
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13328
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: