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NPI Code Detail

MEDICARE: KSENIA MACK PT, DPT

MEDICARE: KSENIA MACK PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070.027296IL
2225100000XPhysical TherapistIL
32251X0800XOrthopedic Physical TherapistIL

General Provider Information

NPI Number : 1033817747
Entity Type Code : Individual
Provider Name (Legal Business Name) : KSENIA MACK PT, DPT
Provider Business Mailing Address
First Line : 2028 N BURLING ST APT 309
Second Line :
City : CHICAGO
State : IL
Zip : 60614-4434
Country : US
Telephone Number : 847-420-6249
Fax Number :
Provider Business Practice Location Address
First Line : 4657 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-2024
Country : US
Telephone Number : 773-989-6472
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2023
Last Update Date : 06/16/2025

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