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General NPI Number Information
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NPI Number | 1720648876
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Entity Type | Organization
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Legal Business Name | JONCOM PT,P.C.
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 360 W BUTTERFIELD RD STE 150
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City | ELMHURST
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State | IL
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Zip | 60126-5099
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Country | US
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Telephone | 630-268-1045
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Fax | 630-268-1047
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Provider Business Mailing Address
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Address Line | 5N425 EAGLE TER
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City | ITASCA
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State | IL
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Zip | 60143-2434
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Country | US
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Telephone | 630-404-1045
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN COMEROUSKI
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Credential | PT
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Telephone | 630-404-1045
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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 |
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