Active NPI
Marzena D Kaniuk, PT
- Physical Therapist
- Addison, IL
National Provider Identifier
1174551162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070-011042
- Practice address
- 1415 W Lake St
Addison, IL 60101 - Phone
- (866) 644-8040
- Fax
- (630) 705-1980
- NPI assigned
- Jun 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070-011042 | IL | Primary |
Addresses
Primary practice location
1415 W Lake St
Addison, IL 60101
Mailing address
3915 30TH Avenue
Kenosha, WI 53144
Phone (877) 552-2996
Other names 1
- Marzena D Kpukar
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070-011042 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174551162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3915 30TH AVENUE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "53144",
"telephone_number": "877-552-2996",
"fax_number": "262-657-7190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1415 W LAKE ST",
"city": "ADDISON",
"state": "IL",
"postal_code": "60101",
"telephone_number": "866-644-8040",
"fax_number": "630-705-1980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANIUK",
"first_name": "MARZENA",
"middle_name": "D",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070-011042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARZENA",
"last_name": "KPUKAR",
"middle_name": "D",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Addison, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.