Provider Demographics
NPI:1679553622
Name:JANES, PAULA ANN (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:ANN
Last Name:JANES
Suffix:
Gender:F
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 1:790 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:
Practice Address - Street 1:57 BEDFORD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4500
Practice Address - Country:US
Practice Address - Phone:781-541-5111
Practice Address - Fax:781-541-5115
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist