Provider Demographics
NPI:1376956649
Name:PAYAGGAPANDHA, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:PAYAGGAPANDHA
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 1:2906 CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-6163
Mailing Address - Country:US
Mailing Address - Phone:217-398-9800
Mailing Address - Fax:217-366-0037
Practice Address - Street 1:30 N LASALLE ST
Practice Address - Street 2:STE 3430
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-269-0099
Practice Address - Fax:312-269-0033
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist