Provider Demographics
NPI:1992780563
Name:SROKA, RICHARD E (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:SROKA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 W NORTH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2135
Mailing Address - Country:US
Mailing Address - Phone:630-832-6919
Mailing Address - Fax:630-832-6928
Practice Address - Street 1:533 W NORTH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2135
Practice Address - Country:US
Practice Address - Phone:630-832-6919
Practice Address - Fax:630-832-6928
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-0119102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL396740OtherMEDICARE GROUP NUMBER
IL396730OtherMEDICARE GROUP NUMBER
ILK22601Medicare PIN