MEDICARE: JENNIFER JANOWSKI MPT

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		IL

General Provider Information

NPI Number	:	1235270117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JANOWSKI MPT

Provider Business Mailing Address
First Line	:	500 N KINGSBURY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-4021
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N KINGSBURY ST
Second Line	:	EAST BANK CLUB
City	:	CHICAGO
State	:	IL
Zip	:	60610-4021
Country	:	US
Telephone Number	:	312-527-5801
Fax Number	:	312-644-4567

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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