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General NPI Number Information
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NPI Number | 1942040159
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Entity Type | Individual
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Provider Name | MADISON ANNE GRZESIAK PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 4657 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2024
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Country | US
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Telephone | 773-989-6472
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Fax |
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Provider Business Mailing Address
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Address Line | 1458 W LEXINGTON ST APT 2B
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City | CHICAGO
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State | IL
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Zip | 60607-4036
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Country | US
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Telephone | 262-422-4592
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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 | 070028308
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License Number State | IL
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