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NPI Code Detail

MEDICARE: DR. JENA TAGLIOLA-IP DPT

MEDICARE: DR. JENA TAGLIOLA-IP DPT
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 Therapist070.022511IL

General Provider Information

NPI Number : 1164977104
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENA TAGLIOLA-IP DPT
Provider Business Mailing Address
First Line : 6349 CAPULINA AVE
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-3105
Country : US
Telephone Number : 773-547-4047
Fax Number :
Provider Business Practice Location Address
First Line : 4657 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-2024
Country : US
Telephone Number : 773-989-6472
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2016
Last Update Date : 12/29/2022

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