MEDICARE: MAXWELL SCOTT JANCZAK 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	070026269	IL

General Provider Information

NPI Number	:	1902476179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXWELL SCOTT JANCZAK PT, DPT

Provider Business Mailing Address
First Line	:	909 W EUCLID AVE UNIT 853
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60006-2134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6285 N KNOX AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-5032
Country	:	US
Telephone Number	:	773-499-9313
Fax Number	:

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

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	05/23/2023

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