Provider Demographics
NPI:1306851167
Name:MOCILAN, JEFF (MS,PT)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:MOCILAN
Suffix:
Gender:M
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:ENERGY
Mailing Address - State:IL
Mailing Address - Zip Code:62933-3567
Mailing Address - Country:US
Mailing Address - Phone:618-988-9593
Mailing Address - Fax:
Practice Address - Street 1:2501 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ENERGY
Practice Address - State:IL
Practice Address - Zip Code:62933-3567
Practice Address - Country:US
Practice Address - Phone:618-988-9593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist