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NPI Code Detail

MEDICARE: MS. JEAN CHENOWETH P.T.A.

MEDICARE: MS. JEAN CHENOWETH P.T.A.
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
1225200000XPhysical Therapy AssistantIL

General Provider Information

NPI Number : 1992810725
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JEAN CHENOWETH P.T.A.
Provider Business Mailing Address
First Line : 1816 170TH ST
Second Line :
City : HAZEL CREST
State : IL
Zip : 60429-1451
Country : US
Telephone Number : 708-335-1415
Fax Number : 708-335-4792
Provider Business Practice Location Address
First Line : 13114 WESTERN AVE
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-2439
Country : US
Telephone Number : 708-824-0515
Fax Number : 708-824-0517
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2006
Last Update Date : 07/08/2007

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