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General NPI Number Information
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NPI Number | 1386167013
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Entity Type | Individual
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Provider Name | MICHELLE A JILEK PT, DPT, OCS
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Gender | Female
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 7010 N FIGHTER COUNTRY AVE
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City | LUKE AFB
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State | AZ
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Zip | 85309-1636
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Country | US
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Telephone | 505-259-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 1470 EVERGREEN DR
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City | RIVER FALLS
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State | WI
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Zip | 54022-5635
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Country | US
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Telephone |
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Fax |
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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 | 26574
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5039
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | LPT-32912
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License Number State | AZ
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