Doctor Name: | JIGEEH MANTUJAC |
NPI Number: | 1538563671 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | 070.018343 |
Business Practice Address: | 4559 Imperial Dr 3e Richton Park, IL - 604712437 |
Business Phone Number: | 2242798709 |
Business Fax Number: | |
Mailing Address: | 4559 Imperial Dr, 3e RICHTON PARK |
State: | IL |
Postal Code: | 604712437 |
Phone Number: | 2242798709 |
Fax Number: | |
NPI Enumeration Date: | 10/17/2014 |
NPI Last Update Date: | 10/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251G0304X |
License Number: | 070.018343 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Geriatrics |
Taxonomy Definition: |