Individual
EWA KOPEC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., P.T.
Contact information
Practice address
3545 LAKE AVE, SUITE 103, WILMETTE, IL 60091-1058
(847) 251-2028
(847) 512-5064
Mailing address
3545 LAKE AVE, SUITE 103, WILMETTE, IL 60091-1058
(847) 251-2028
(847) 512-5064
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
70015237
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01634372
BCI BCBS GROUP NO.
IL
01
—
1618443
PEAK BCBS GROUP NO.
IL
01
—
200573902
BCI TAX ID
IL
05
—
236963283001
—
IL
01
—
363396874
PEAK TAX ID
IL
Enumeration date
08/20/2007
Last updated
07/22/2008
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