=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275084519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IRON PERFORMANCE P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2016
-----------------------------------------------------
Last Update Date | 10/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27W 117 GENEVA RD
-----------------------------------------------------
City | WINFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60190-2038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-335-0280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27W 117 GENEVA RD
-----------------------------------------------------
City | WINFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60190-2038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. MARK PAPCIAK
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 630-335-0280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 060011882
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------