Provider Demographics
NPI:1386440949
Name:MECISAMENTE, JUNEVA
Entity type:Individual
Prefix:
First Name:JUNEVA
Middle Name:
Last Name:MECISAMENTE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 PEARSON ST APT 801
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-9213
Mailing Address - Country:US
Mailing Address - Phone:773-701-2307
Mailing Address - Fax:
Practice Address - Street 1:750 PEARSON ST APT 801
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-9213
Practice Address - Country:US
Practice Address - Phone:773-701-2307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics