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General NPI Number Information
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NPI Number | 1275211641
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Entity Type | Individual
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Provider Name | KIMBERLY RAE STANCZAK PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 42 S WEBER RD
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City | ROMEOVILLE
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State | IL
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Zip | 60446-4947
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Country | US
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Telephone | 630-856-6479
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Fax |
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Provider Business Mailing Address
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Address Line | 2S416 EMERALD GREEN DR UNIT E
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City | WARRENVILLE
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State | IL
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Zip | 60555-2125
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Country | US
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Telephone | 630-877-2141
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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 | 070026202
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License Number State | IL
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