MEDICARE: JAN A VLASAK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6256	WI

General Provider Information

NPI Number	:	1073786372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN A VLASAK PT

Provider Business Mailing Address
First Line	:	7300 WASHINGTON AVE
Second Line	:	SUITE B
City	:	RACINE
State	:	WI
Zip	:	53406-3821
Country	:	US
Telephone Number	:	262-321-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 WASHINGTON AVE
Second Line	:	SUITE B
City	:	RACINE
State	:	WI
Zip	:	53406-3821
Country	:	US
Telephone Number	:	262-321-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/08/2008

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Directions to “ JAN A VLASAK PT” Practice Location

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