MEDICARE: MRS. JEANNINE PATRICIA DUNNELL 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		IL

General Provider Information

NPI Number	:	1932118510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANNINE PATRICIA DUNNELL P.T.

Provider Business Mailing Address
First Line	:	342 MEADOW LN
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2424
Country	:	US
Telephone Number	:	847-438-8759
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 OAKTON ST
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1958
Country	:	US
Telephone Number	:	847-692-6964
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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