MEDICARE: JENESSA NOWAK ZARAGOZA 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	070016710	IL

General Provider Information

NPI Number	:	1891094348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENESSA NOWAK ZARAGOZA DPT

Provider Business Mailing Address
First Line	:	361 S FRONTAGE RD
Second Line	:	SUITE 124
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-5830
Country	:	US
Telephone Number	:	630-920-4670
Fax Number	:	630-920-4689

Provider Business Practice Location Address
First Line	:	1255 S STATE ST
Second Line	:	UNIT 6
City	:	CHICAGO
State	:	IL
Zip	:	60605-1928
Country	:	US
Telephone Number	:	312-880-0808
Fax Number	:	312-880-0810

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

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	08/09/2016

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