Provider Demographics
NPI:1023000726
Name:MAIDA, JILL M (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:MAIDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18W431 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4142
Practice Address - Country:US
Practice Address - Phone:630-620-1580
Practice Address - Fax:630-620-1588
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2993010Medicare PIN
ILP00438886Medicare PIN
ILK38361Medicare PIN
ILP00438886Medicare PIN