Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 070023822 | IL |
NPI | 1114407285 |
---|---|
Provider Name | Ms. Jenna Rae Urbaniak I |
First Address | Chicago, IL 60613-2407 |
Second Address | Chicago, IL 60613-2407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2018 |
Last Update Date | 18/08/2018 |