Provider Demographics
NPI:1992013379
Name:PANCHAL, JIGAR (PT)
Entity type:Individual
Prefix:
First Name:JIGAR
Middle Name:
Last Name:PANCHAL
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 1:2134 STIRLING CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-2962
Mailing Address - Country:US
Mailing Address - Phone:630-329-2170
Mailing Address - Fax:
Practice Address - Street 1:2021 MIDWEST RD STE 103
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-8902
Practice Address - Country:US
Practice Address - Phone:630-451-9020
Practice Address - Fax:630-451-9025
Is Sole Proprietor?:No
Enumeration Date:2010-09-19
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist