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

Table of content: SAMAHARA OLMEDO CAZARES (NPI 1124972476)

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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