Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | IL |
NPI | 1134254840 |
---|---|
Provider Name | Cecilia Horodyski |
First Address | Chicago, IL 60639-2316 |
Second Address | Chicago, IL 60608-2647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CH83440698P | EARLY INTERVENTION (01) | IL |