Provider Demographics
NPI:1508871922
Name:SEIZ, JANNA LOUISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANNA
Middle Name:LOUISE
Last Name:SEIZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 S PAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:PAWNEE
Mailing Address - State:IL
Mailing Address - Zip Code:62558-9134
Mailing Address - Country:US
Mailing Address - Phone:217-341-4948
Mailing Address - Fax:217-625-2917
Practice Address - Street 1:15400 S PAWNEE RD
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:IL
Practice Address - Zip Code:62558-9134
Practice Address - Country:US
Practice Address - Phone:217-341-4948
Practice Address - Fax:217-625-2917
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL494547070001Medicaid
IL207128Medicare PIN