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General NPI Number Information
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NPI Number | 1023325818
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Entity Type | Individual
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Provider Name | MAGDALENA M CHOWANIEC PTA
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Gender | Male
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 4555 OAKTON ST
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City | SKOKIE
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State | IL
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Zip | 60076-3178
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Country | US
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Telephone | 847-982-9988
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Fax | 847-982-9789
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Provider Business Mailing Address
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Address Line | 816 JUNIPER RD
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City | GLENVIEW
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State | IL
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Zip | 60025-3320
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Country | US
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Telephone | 312-403-9800
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Fax | 847-998-9801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160002202
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License Number State | IL
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