Provider Demographics
NPI:1093766909
Name:HARMS, JAMIE MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:MARIE
Last Name:HARMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:MARIE
Other - Last Name:MELGAREJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:500 N KINGSBURY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5721
Mailing Address - Country:US
Mailing Address - Phone:312-527-5801
Mailing Address - Fax:
Practice Address - Street 1:1915 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1618
Practice Address - Country:US
Practice Address - Phone:312-674-9132
Practice Address - Fax:312-674-9392
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200765OtherGROUP MEDICARE PIN
IL070014443OtherSTATE LICENSE
IL070014443OtherSTATE LICENSE