MEDICARE: WLODARSKI THERAPY GROUP PC

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	225100000X	Physical Therapist	070006747	IL

General Provider Information

NPI Number	:	1669590816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WLODARSKI THERAPY GROUP PC

Provider Business Mailing Address
First Line	:	4005 N NASHVILLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1428
Country	:	US
Telephone Number	:	773-777-9871
Fax Number	:	773-777-9872

Provider Business Practice Location Address
First Line	:	4005 N NASHVILLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1428
Country	:	US
Telephone Number	:	773-777-9871
Fax Number	:	773-777-9872

Authorized Official
Title or Position	:	PRESIDENT PT
Name	:	WIESLAW WLODARSKI
Credential	:	PT
Telephone Number	:	773-777-9871

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/25/2008

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