Individual
MRS. JACQUELINE A TEZAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
515 HANNIGAN DR, MINOOKA, IL 60447-9475
(815) 715-9545
Mailing address
515 HANNIGAN DR, MINOOKA, IL 60447-9475
(815) 715-9545
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.000503
IL
Other
Enumeration date
08/15/2011
Last updated
08/15/2011
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