MEDICARE: MICHAEL JOHN GENON JUMAO-AS PT,DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070028690	IL

General Provider Information

NPI Number	:	1598583692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOHN GENON JUMAO-AS PT,DPT

Provider Business Mailing Address
First Line	:	608 LORREE LN
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-5228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 LORREE LN
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-5228
Country	:	US
Telephone Number	:	606-233-6617
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2024
Last Update Date	:	02/18/2025

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