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General NPI Number Information
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NPI Number | 1265971592
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Entity Type | Individual
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Provider Name | AGNIESZKA KISIEL-MUCHA
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Gender | Female
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 4515 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-3711
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Country | US
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Telephone | 312-671-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 3837 N PARIS AVE
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City | CHICAGO
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State | IL
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Zip | 60634-2043
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Country | US
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Telephone | 847-977-2953
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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 | 070.022782
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License Number State | IL
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