Provider Demographics
NPI:1306652045
Name:MROCZEK, PAULINA (DPT)
Entity type:Individual
Prefix:
First Name:PAULINA
Middle Name:
Last Name:MROCZEK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N MAIN STREET
Mailing Address - Street 2:STE. 101
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-670-1111
Mailing Address - Fax:847-670-1113
Practice Address - Street 1:609 N MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2160
Practice Address - Country:US
Practice Address - Phone:847-670-1111
Practice Address - Fax:847-670-1113
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.028777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist