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General NPI Number Information
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NPI Number | 1790678084
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Entity Type | Individual
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Provider Name | MADILYN JANKILA
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Gender | Female
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 1405 PROGRESS PKWY STE 100
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City | VIRGINIA
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State | MN
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Zip | 55792-3068
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Country | US
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Telephone | 218-248-2102
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Fax |
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Provider Business Mailing Address
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Address Line | 3835 SUPREME CT NW STE 2
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City | BEMIDJI
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State | MN
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Zip | 56601-4485
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Country | US
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Telephone | 218-441-5232
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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 |
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License Number State |
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