Active NPI
Jigeeh Mantujac, PT
- Geriatric Physical Therapist
- Richton Park, IL
National Provider Identifier
1538563671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- 070.018343
- Practice address
- 4559 Imperial Dr
3E
Richton Park, IL 60471-2437 - Phone
- (224) 279-8709
- NPI assigned
- Oct 17, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 070.018343 | IL | Primary |
Addresses
Primary practice location
4559 Imperial Dr
3E
Richton Park, IL 60471-2437
Mailing address
4559 Imperial Dr
3E
Richton Park, IL 60471-2437
Phone (224) 279-8709
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.018343 | IL | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413504000000",
"number": "1538563671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4559 IMPERIAL DR",
"address_2": "3E",
"city": "RICHTON PARK",
"state": "IL",
"postal_code": "604712437",
"telephone_number": "224-279-8709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4559 IMPERIAL DR",
"address_2": "3E",
"city": "RICHTON PARK",
"state": "IL",
"postal_code": "604712437",
"telephone_number": "224-279-8709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANTUJAC",
"first_name": "JIGEEH",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-10-17",
"last_updated": "2014-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "IL",
"license": "070.018343",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richton Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.