Basic Information
| Provider Information | |||||||||
| NPI: | 1750563094 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYLESWORTH | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | JANSSEN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 910 W VAN BUREN ST | ||||||||
| Address2: | SUITE 419 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606073523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777091090 | ||||||||
| FaxNumber: | 6308769187 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S COUNTY FARM RD | ||||||||
| Address2: | STE 310 | ||||||||
| City: | WHEATON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601874547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777091090 | ||||||||
| FaxNumber: | 6308769187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2007 | ||||||||
| LastUpdateDate: | 04/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070-008677 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.