MEDICARE: MRS. PAULA ANN JANES M.S., P.T.

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	15136	MA

General Provider Information

NPI Number	:	1679553622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAULA ANN JANES M.S., P.T.

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	:

Provider Business Practice Location Address
First Line	:	57 BEDFORD ST
Second Line	:	SUITE 202
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4500
Country	:	US
Telephone Number	:	781-541-5111
Fax Number	:	781-541-5115

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	04/29/2016

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