Healthcare Provider Details

I. General information

NPI: 1154968295
Provider Name (Legal Business Name): JYOTI JANI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 FORREST AVE STE 101
DOVER DE
19904-3483
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 302-735-4900
  • Fax:
Mailing address:
  • Phone: 803-812-3656
  • Fax: 410-648-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number045199
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0014736
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: