1811054091 NPI number — PAULA P. JOHNSON STRASKY PT, MOMT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811054091 NPI number — PAULA P. JOHNSON STRASKY PT, MOMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON STRASKY
Provider First Name:
PAULA
Provider Middle Name:
P.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, MOMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
PAULA
Provider Other Middle Name:
PIASECKI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, MOMT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1811054091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E WALTON ST
Provider Second Line Business Mailing Address:
STE. 700
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-1448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-642-3963
Provider Business Mailing Address Fax Number:
312-642-3966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 MACOM DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60564-9358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
331-213-7247
Provider Business Practice Location Address Fax Number:
331-457-5749
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070.003092 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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