JEROLD E DAVIS (NPI# 1588773352) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588773352 |
| Entity Type | Individual |
| Full Name | JEROLD E DAVIS |
| Credential | PT, OCS |
| Practice Address |
17517 80th Ave Tinley Park IL 60477-6501 |
| Practice Telephone | 7084294814 |
| Practice Fax Number | 7084299174 |
| Mailing Telephone | 7084294814 |
| Mailing Fax Number | 7084299174 |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2019-09-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 2251X0800X |
Physical Therapist Specialization: Orthopedic |
070006019 | IL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | NPI | 1588773352 | 01 |
| IL | LICENSE # | 070006019 | 01 |
| Street Address |
17517 80TH AVE |
| City | TINLEY PARK |
| State | IL |
| Zip Code | 60477-6501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578522496 | Select Physical Therapy Orthopedic Services Inc | Clinic/Center | 17517 80th Ave, Tinley Park, IL 60477-6501 | 2006-03-20 |
| 1629682703 | Rci (wrs), LLC. | Clinic/Center | 17517 80th Ave, Tinley Park, IL 60477-6501 | 2020-09-04 |
| 1770653503 | Lynda Pekala | Physical Therapy Assistant | 17517 80th Ave, Tinley Park, IL 60477-6501 | 2006-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013522366 | Joshua Gruenke | Physical Therapist | 17129 S. Harlem Avenue, Tinley Park, IL 60477 | 2020-09-14 |
| 1881229656 | Sherrie Lynn Tsang | Massage Therapist | 7925 West 171st Street, Tinley Park, IL 60477 | 2020-03-11 |
| 1437782117 | Du Page Medical Group Ltd | Durable Medical Equipment & Medical Supplies | 17129 S Harlem Ave. Ste B3, Tinley Park, IL 60477 | 2020-02-20 |
| 1356998561 | Rasa Vaskeviciute | Physical Therapist | 17129 So Harlem, Tinley Park, IL 60477 | 2019-08-22 |
| 1538728258 | Michelle Anne Wisen | Physical Therapy Assistant | 17129 South Harlem, Suite B3, Tinley Park, IL 60477 | 2019-06-06 |
| 1073006151 | Danielle Lyon | Counselor | 6801 West 180th Court, Tinley Park, IL 60477 | 2018-06-13 |
| 1316445794 | Yvonne Tran | Physical Therapist | 17129 S Harlem Ave, Tinley Park, IL 60477 | 2018-01-31 |
| 1326574591 | Nicholas Barker | Chronic Disease Hospital | 7859 Joliet Drive North, Tinley Park, IL 60477 | 2017-05-10 |
| 1982063632 | Nicole Kristine Demarco | Specialist/Technologist | 16317 Clark Ln, Tinley Park, IL 60477 | 2016-02-22 |
| 1376900571 | Ucp Seguin Greater Chicago | Foster Care Agency | 7550 W. 183rd, Tinley Park, IL 60477 | 2016-01-20 |
| Find all providers in zip 60477 | ||||
| Taxonomy Code | 2251X0800X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Orthopedic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154675700 | Donald A Williams Jr. | Physical Therapist | 6701 159th St, Tinley Park, IL 60477-1758 | 2012-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659986891 | Murtaza Aziz | Physical Therapist | 1431 N Western Ave Ste 140, Chicago, IL 60622-1770 | 2020-09-14 |
| 1902416720 | Epicore Physical Therapy | Physical Therapist | 1660 N La Salle Dr Apt 2708, Chicago, IL 60614-6021 | 2020-08-06 |
| 1356968374 | Genevieve Joy Owen | Physical Therapist | 555 Busse Hwy Unit C1, Park Ridge, IL 60068-3189 | 2020-06-26 |
| 1518597772 | Stability Physical Therapy and Wellness, LLC | Physical Therapist | 5031 W Balmoral Ave, Chicago, IL 60630-1507 | 2020-01-16 |
| 1154972719 | Antonio Marquez | Physical Therapist | 7425 Janes Ave Ste 200, Woodridge, IL 60517-2358 | 2019-09-25 |
| 1376198978 | Natalie N Ruebke | Physical Therapist | 251 Marketplace Dr # 2, Freeburg, IL 62243-4082 | 2019-08-09 |
| 1902360241 | Stephanie Lynne Burkhart | Physical Therapist | 12251 W 159th St, Homer Glen, IL 60491-7847 | 2019-01-30 |
| 1003388943 | Scoliosis Therapy Care and More LLC | Physical Therapist | 4n369 Booth Tarkington St, St Charles, IL 60175-7731 | 2018-12-17 |
| 1912478082 | Brandon Donnelly | Physical Therapist | 2200 Fort Jesse Rd Ste 230, Normal, IL 61761-6291 | 2018-12-16 |
| 1497251086 | John William Herbert | Physical Therapist | 1316 N Route 59, Naperville, IL 60563-4286 | 2018-04-03 |
| Find all providers with the same taxonomy | ||||
| City | TINLEY PARK |
| Zip Code | 60477 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.