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NPI Code Detail

MEDICARE: JILL V. DZIAK P.T.A.

MEDICARE: JILL V. DZIAK P.T.A.
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
1225200000XPhysical Therapy AssistantIL

General Provider Information

NPI Number : 1528237450
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL V. DZIAK P.T.A.
Provider Business Mailing Address
First Line : 9901 LINN STATION RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-3808
Country : US
Telephone Number : 800-866-0860
Fax Number :
Provider Business Practice Location Address
First Line : 1040 ROBEY AVE
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60516-3445
Country : US
Telephone Number : 630-969-9188
Fax Number : 630-969-6224
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2008
Last Update Date : 03/06/2008

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