Provider Demographics
NPI:1902925308
Name:SKULSKI, DANUTA (PTA)
Entity Type:Individual
Prefix:
First Name:DANUTA
Middle Name:
Last Name:SKULSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4847 W ELSON
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60691
Mailing Address - Country:US
Mailing Address - Phone:773-725-5004
Mailing Address - Fax:773-725-5004
Practice Address - Street 1:3633 WEST LAKE AVE
Practice Address - Street 2:#102 MEDCARE
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5808
Practice Address - Country:US
Practice Address - Phone:847-724-7600
Practice Address - Fax:847-724-7693
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
209349Medicare ID - Type Unspecified
144528Medicare ID - Type Unspecified