Provider Demographics
NPI:1720167885
Name:ZOLNA-PITTS, JOCELYN TAUTERIS (PT)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:TAUTERIS
Last Name:ZOLNA-PITTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:
Other - Last Name:ZOLNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:24014 W RENWICK RD STE F
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8708
Mailing Address - Country:US
Mailing Address - Phone:800-974-4378
Mailing Address - Fax:630-515-1536
Practice Address - Street 1:20 S CLARK ST STE 1020
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-1858
Practice Address - Country:US
Practice Address - Phone:800-974-4378
Practice Address - Fax:630-515-1536
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP006511085Medicare PIN
ILR03716Medicare PIN
ILK47091Medicare PIN
ILR00841Medicare PIN
ILR03623Medicare PIN