MEDICARE: MISS HENRYKA PIETKIEWICZ

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	070006941	IL

General Provider Information

NPI Number	:	1730312125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS HENRYKA PIETKIEWICZ

Provider Business Mailing Address
First Line	:	11219 W 159TH ST
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-4416
Country	:	US
Telephone Number	:	773-767-8088
Fax Number	:	773-767-8221

Provider Business Practice Location Address
First Line	:	11219 W 159TH ST
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-4416
Country	:	US
Telephone Number	:	773-767-8088
Fax Number	:	773-767-8221

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

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	09/01/2009

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Directions to “ MISS HENRYKA PIETKIEWICZ ” Practice Location

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