Provider Demographics
NPI:1679962989
Name:WODZIEN, KRZYSZTOF P (PTA, PBT)
Entity type:Individual
Prefix:
First Name:KRZYSZTOF
Middle Name:P
Last Name:WODZIEN
Suffix:
Gender:M
Credentials:PTA, PBT
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:P
Other - Last Name:WODZIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5401 N MILWAUKEE AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1200
Mailing Address - Country:US
Mailing Address - Phone:773-895-3589
Mailing Address - Fax:
Practice Address - Street 1:5401 N MILWAUKEE AVE APT 1B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1200
Practice Address - Country:US
Practice Address - Phone:773-895-3589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.006692225200000X
IL34950-25299956246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy