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General NPI Number Information
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NPI Number | 1467099028
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Entity Type | Organization
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Legal Business Name | PT X AJ INC
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Dates
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Enumeration Date | 12/03/2019
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 3717 N RAVENSWOOD AVE STE 110
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City | CHICAGO
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State | IL
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Zip | 60613-3880
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Country | US
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Telephone | 872-201-4665
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Fax | 949-404-8431
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Provider Business Mailing Address
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Address Line | 3804 N BELL AVE
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City | CHICAGO
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State | IL
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Zip | 60618-3812
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Country | US
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Telephone | 847-858-2257
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALISON ANN JASINOWSKI HAYMAN
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Credential | PT, DPT, OCS
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Telephone | 872-201-4665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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