Individual provider Active NPI

Diane Frances Kolarczyk, P.T.

  • Physical Therapist
  • Gary, IN
National Provider Identifier
1720103294
Registry record updated Jun 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
05002003A Issued in IN
Practice address
7501 W 15TH Ave
Gary, IN 46406-2267
Phone
(219) 977-2092
Fax
(219) 977-2091
NPI assigned
Mar 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 05002003A IN Primary

Addresses

Primary practice location

7501 W 15TH Ave
Gary, IN 46406-2267

Mailing address

205 W Wacker Dr
Suite 1020
Chicago, IL 60606-1216
Phone (312) 640-0329

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041022000962 IN Practitioner - Physical Therapist in Private Practice 6002877024 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05002003AINMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Premise Health of Indiana Medical, P.C. Current Accepting new patients
Integrated Therapy Practice, PC Physical Therapist PastSince May 1, 2016 Accepting new patients
Integrated Therapy Practice Physical Therapist Past Accepting new patients
Accelerated Rehabilitation Centers LTD Physical Therapist Past Accepting new patients
Connecticut General Life Insurance Company Past Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245283200000",
    "number": "1720103294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W WACKER DR",
            "address_2": "SUITE 1020",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606061216",
            "telephone_number": "312-640-0329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7501 W 15TH AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464062267",
            "telephone_number": "219-977-2092",
            "fax_number": "219-977-2091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLARCZYK",
        "first_name": "DIANE",
        "middle_name": "FRANCES",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2009-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05002003A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gary, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.