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NPI Code Detail

MEDICARE: JANELL MARIE EISENHUT PT

MEDICARE: JANELL MARIE EISENHUT 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
1225100000XPhysical Therapist05010680AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073883641
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANELL MARIE EISENHUT PT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2223
Fax Number : 630-759-3251
Provider Business Practice Location Address
First Line : 4020 COLUMBUS AVE
Second Line :
City : ANDERSON
State : IN
Zip : 46013-5010
Country : US
Telephone Number : 765-641-7605
Fax Number : 765-641-7607
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2012
Last Update Date : 06/04/2012

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