Provider Demographics
NPI:1649658154
Name:PRZEKWAS, MARY L (ATC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:PRZEKWAS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 VIOLET CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9225
Mailing Address - Country:US
Mailing Address - Phone:630-544-8950
Mailing Address - Fax:
Practice Address - Street 1:2277 MARTHA BERRY HWY NW
Practice Address - Street 2:
Practice Address - City:MOUNT BERRY
Practice Address - State:GA
Practice Address - Zip Code:30149-9707
Practice Address - Country:US
Practice Address - Phone:706-232-5374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0031702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer