Provider Demographics
NPI:1033508395
Name:JAGLIN, CATHLEEN ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CATHLEEN
Middle Name:ANNE
Last Name:JAGLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 S CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-3200
Mailing Address - Country:US
Mailing Address - Phone:630-960-2026
Mailing Address - Fax:
Practice Address - Street 1:6501 S CASS AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-3200
Practice Address - Country:US
Practice Address - Phone:630-960-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.010345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist