Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070-009980 | IL |
N | 2251G0304X | Physical Therapist - Geriatrics | ||
N | 2251H1200X | Hand | ||
N | 2251H1300X | Human Factors | ||
N | 225XH1300X | Human Factors | ||
N | 2251N0400X | Physical Therapist - Neurology | ||
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1558411561 |
---|---|
Provider Name | Mr. Piotr Norbert Domagala |
First Address | Prospect Heights, IL 60070-1022 |
Second Address | Mount Prospect, IL 60056-3444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 21/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
K06200 | (02) |