MEDICARE: JENNIFER KAMIENIAK 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
1	225100000X	Physical Therapist	07008354	IL
2	225100000X	Physical Therapist	070.018354	IL

General Provider Information

NPI Number	:	1558611590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KAMIENIAK DPT

Provider Business Mailing Address
First Line	:	720 W GORDON TER UNIT 17B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2269
Country	:	US
Telephone Number	:	773-255-3671
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 W GORDON TER APT 17B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2263
Country	:	US
Telephone Number	:	773-255-3671
Fax Number	:

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

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	03/17/2018

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