Provider Demographics
NPI:1407982069
Name:SWIATKOWSKI, BERNADETTE A (PT)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:A
Last Name:SWIATKOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3173
Mailing Address - Country:US
Mailing Address - Phone:815-463-1885
Mailing Address - Fax:815-463-1885
Practice Address - Street 1:1076 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-3173
Practice Address - Country:US
Practice Address - Phone:815-463-1885
Practice Address - Fax:815-463-1885
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist