Provider Demographics
NPI:1033743117
Name:BEDZYK, JENI MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:JENI
Middle Name:MARIE
Last Name:BEDZYK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 TIMBERVIEW LN
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-9577
Mailing Address - Country:US
Mailing Address - Phone:517-677-8268
Mailing Address - Fax:
Practice Address - Street 1:275 S LASALLE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4298
Practice Address - Country:US
Practice Address - Phone:630-897-6947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.008491225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant