MEDICARE: SYDNEY SOBKOWIAK 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	160.009842	IL

General Provider Information

NPI Number	:	1760243869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY SOBKOWIAK PTA

Provider Business Mailing Address
First Line	:	33900 HARPER AVE STE 104
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:	586-350-2644
Fax Number	:

Provider Business Practice Location Address
First Line	:	8057 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-2003
Country	:	US
Telephone Number	:	773-922-0105
Fax Number	:	773-922-0106

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

Provider Enumeration Date	:	01/17/2024
Last Update Date	:	01/17/2024

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Directions to “ SYDNEY SOBKOWIAK PTA” Practice Location

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