MEDICARE: MS. JAIME VANDER ZANDEN 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	05010208A	IN
2	225100000X	Physical Therapist	070-017591	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01011167	OTHER	IN	MEDICARE RR

General Provider Information

NPI Number	:	1982663373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAIME VANDER ZANDEN DPT

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-1980
Fax Number	:	630-928-5080

Provider Business Practice Location Address
First Line	:	5601 W MONEE MANHATTAN RD STE 115
Second Line	:
City	:	MONEE
State	:	IL
Zip	:	60449-8866
Country	:	US
Telephone Number	:	708-314-7761
Fax Number	:	708-314-7762

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	08/10/2023

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