Basic Information
| Provider Information | |||||||||
| NPI: | 1356578819 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AGUILING | ||||||||
| FirstName: | JAN MICHAEL | ||||||||
| MiddleName: | PASTRANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 609 CHESTERFIELD COMMONS | ||||||||
| Address2: | APT F | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628642183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124492984 | ||||||||
| FaxNumber: | 8124696876 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 RICKER RD | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628814263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185483194 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2009 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070015383 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.