Provider Demographics
NPI:1376677831
Name:MADEJA, EMILY JO
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JO
Last Name:MADEJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 N CAMPBELL AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3153
Mailing Address - Country:US
Mailing Address - Phone:716-983-8806
Mailing Address - Fax:
Practice Address - Street 1:5150 CAPITOL DR
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-7900
Practice Address - Country:US
Practice Address - Phone:847-215-9977
Practice Address - Fax:847-215-9376
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist