Provider Demographics
NPI:1548246580
Name:BENKOWSKI, TRACY ANN (MHS, PT)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ANN
Last Name:BENKOWSKI
Suffix:
Gender:F
Credentials:MHS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:4220 W 95TH ST
Practice Address - Street 2:STE 100
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2793
Practice Address - Country:US
Practice Address - Phone:708-226-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK18009Medicare ID - Type UnspecifiedDUPAGE COUNTY
ILK18010Medicare ID - Type UnspecifiedCOOK COUNTY