MEDICARE: DANUTA KURDEK PTA

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
1	225200000X	Physical Therapy Assistant		IL

General Provider Information

NPI Number	:	1396967717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANUTA KURDEK PTA

Provider Business Mailing Address
First Line	:	1708 N 73RD AVE
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707
Country	:	US
Telephone Number	:	708-453-9864
Fax Number	:

Provider Business Practice Location Address
First Line	:	3633 WEST LAKE AVE
Second Line	:	MEDCARE #102
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5808
Country	:	US
Telephone Number	:	847-724-7600
Fax Number	:	847-724-7693

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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