Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070022241 | IL |
N | 2251S0007X | Physical Therapist - Sports | 070022241 | IL |
NPI | 1508212374 |
---|---|
Provider Name | Dr. Jakob Awender |
First Address | Clinton Twp, MI 48035-4258 |
Second Address | Algonquin, IL 60102-9700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2016 |
Last Update Date | 11/03/2021 |