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General NPI Number Information
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NPI Number | 1376956649
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Entity Type | Individual
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Provider Name | JILL PAYAGGAPANDHA
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Gender | Female
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 30 N LASALLE ST STE 3430
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City | CHICAGO
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State | IL
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Zip | 60602
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Country | US
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Telephone | 312-269-0099
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Fax | 312-269-0033
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Provider Business Mailing Address
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Address Line | 2906 CROSSING CT
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City | CHAMPAIGN
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State | IL
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Zip | 61822-6163
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Country | US
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Telephone | 217-398-9800
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Fax | 217-366-0037
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | IL
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