MEDICARE: JUDY JICINSKY P.T.

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	208100000X	Physical Medicine & Rehabilitation Physician	02851	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00062328	OTHER	IA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	30406	OTHER	IA	WELLMARK BCBS
3	F232553	OTHER	IA	MIDLANDS CHOICE

General Provider Information

NPI Number	:	1871509224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY JICINSKY P.T.

Provider Business Mailing Address
First Line	:	1585 EAGLE VIEW CT NW
Second Line	:
City	:	SWISHER
State	:	IA
Zip	:	52338-9437
Country	:	US
Telephone Number	:	319-981-2276
Fax Number	:	319-363-2903

Provider Business Practice Location Address
First Line	:	625 32ND AVE SW
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52404-3947
Country	:	US
Telephone Number	:	319-363-2901
Fax Number	:	319-363-2903

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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Directions to “ JUDY JICINSKY P.T.” Practice Location

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