Provider Demographics
NPI:1033315098
Name:RAY, JESSICA MAI (DPT)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MAI
Last Name:RAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:MAI
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:548 E SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:ARCOLA
Practice Address - State:IL
Practice Address - Zip Code:61910-1801
Practice Address - Country:US
Practice Address - Phone:217-268-3188
Practice Address - Fax:217-268-4360
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid