Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 12743903 | IL |
NPI | 1023336823 |
---|---|
Provider Name | Ms. Teresa Maciejczyk |
First Address | Evanston, IL 60201-3704 |
Second Address | Evanston, IL 60201-3704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2010 |
Last Update Date | 24/06/2010 |