Provider Demographics
NPI:1336445170
Name:JAYASENA, WANASINGHE (PT)
Entity Type:Individual
Prefix:
First Name:WANASINGHE
Middle Name:
Last Name:JAYASENA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WAUKEGAN RD
Mailing Address - Street 2:STE 300
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2757
Mailing Address - Country:US
Mailing Address - Phone:847-724-7600
Mailing Address - Fax:
Practice Address - Street 1:211 WAUKEGAN RD
Practice Address - Street 2:STE 300
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2757
Practice Address - Country:US
Practice Address - Phone:847-724-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700090932251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports