Provider Demographics
NPI:1215120647
Name:LUTNICKA, ZOFIA ANNA (LCMT)
Entity type:Individual
Prefix:
First Name:ZOFIA
Middle Name:ANNA
Last Name:LUTNICKA
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 W HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3605
Mailing Address - Country:US
Mailing Address - Phone:773-772-2660
Mailing Address - Fax:
Practice Address - Street 1:2017 W HADDON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3605
Practice Address - Country:US
Practice Address - Phone:773-772-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist