Provider Demographics
NPI:1396896692
Name:SLEZAK, TAMMY J (PTA)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:J
Last Name:SLEZAK
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 1:3210 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3003
Mailing Address - Country:US
Mailing Address - Phone:708-484-5956
Mailing Address - Fax:
Practice Address - Street 1:2930 S MICHIGAN AVE STE 107
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3270
Practice Address - Country:US
Practice Address - Phone:312-842-3919
Practice Address - Fax:312-842-3914
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
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