Provider Demographics
NPI:1811054091
Name:JOHNSON STRASKY, PAULA P (PT, MOMT)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:P
Last Name:JOHNSON STRASKY
Suffix:
Gender:F
Credentials:PT, MOMT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:PIASECKI
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, MOMT
Mailing Address - Street 1:100 E WALTON ST
Mailing Address - Street 2:STE. 700
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1448
Mailing Address - Country:US
Mailing Address - Phone:312-642-3963
Mailing Address - Fax:312-642-3966
Practice Address - Street 1:1315 MACOM DR
Practice Address - Street 2:SUITE 105
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9358
Practice Address - Country:US
Practice Address - Phone:331-213-7247
Practice Address - Fax:331-457-5749
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.003092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146636Medicare PIN