Provider Demographics
NPI:1962740480
Name:HEALTHY CONNECTION PHYSICAL MEDICINE ADDISON
Entity type:Organization
Organization Name:HEALTHY CONNECTION PHYSICAL MEDICINE ADDISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PUODZIUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-599-0950
Mailing Address - Street 1:190 N SWIFT RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-1476
Mailing Address - Country:US
Mailing Address - Phone:630-599-0950
Mailing Address - Fax:630-599-0952
Practice Address - Street 1:190 N SWIFT RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1476
Practice Address - Country:US
Practice Address - Phone:630-599-0950
Practice Address - Fax:630-599-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty