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NPI Code Detail

MEDICARE: MR. DAVID CZARNECKI PTA

MEDICARE: MR. DAVID CZARNECKI 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
1225200000XPhysical Therapy Assistant160000470IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1160000470OTHERILLICENSE

General Provider Information

NPI Number : 1760520217
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID CZARNECKI PTA
Provider Business Mailing Address
First Line : 13114 WESTERN AVE
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-2439
Country : US
Telephone Number : 708-824-0515
Fax Number : 708-824-0517
Provider Business Practice Location Address
First Line : 13114 WESTERN AVE
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-2439
Country : US
Telephone Number : 708-824-0515
Fax Number : 708-824-0517
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2007
Last Update Date : 05/21/2012

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Directions to “ MR. DAVID CZARNECKI PTA” Practice Location

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