Provider Demographics
NPI:1912245739
Name:ZAWACKI, LAURA (MS,PT,PCS)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:ZAWACKI
Suffix:
Gender:F
Credentials:MS,PT,PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 N ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1352
Mailing Address - Country:US
Mailing Address - Phone:708-358-1984
Mailing Address - Fax:
Practice Address - Street 1:923 N ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1352
Practice Address - Country:US
Practice Address - Phone:708-358-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0076862251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics