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General NPI Number Information
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NPI Number | 1093983751
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Entity Type | Individual
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Provider Name | IWONA LACIAK P.T.
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Gender | Female
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 14330 S WILL COOK RD
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City | HOMER GLEN
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State | IL
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Zip | 60491-9211
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Country | US
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Telephone | 708-645-0288
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Fax | 708-349-7430
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Provider Business Mailing Address
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Address Line | 90 ROSE CT
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City | LEMONT
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State | IL
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Zip | 60439-7404
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Country | US
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Telephone | 630-699-4839
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070007510
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License Number State | IL
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