Provider Demographics
NPI:1912381187
Name:MAGLALANG, JENNEFE B (PT)
Entity Type:Individual
Prefix:
First Name:JENNEFE
Middle Name:B
Last Name:MAGLALANG
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 1:8135 N WISNER ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2436
Mailing Address - Country:US
Mailing Address - Phone:224-250-5748
Mailing Address - Fax:
Practice Address - Street 1:8135 N WISNER ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2436
Practice Address - Country:US
Practice Address - Phone:224-250-5748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70015075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist