Provider Demographics
NPI:1457443459
Name:JOVANOVICH, CYNTHIA M (DPT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:JOVANOVICH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:M
Other - Last Name:QUANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
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:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:1210 STATE ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4489
Practice Address - Country:US
Practice Address - Phone:630-296-3103
Practice Address - Fax:630-243-1203
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00615729Medicare PIN
ILK27473Medicare PIN