Provider Demographics
NPI:1235271024
Name:EUN, JANE SOO (MPT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:SOO
Last Name:EUN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:YUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
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:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:500 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2307
Practice Address - Country:US
Practice Address - Phone:630-607-1820
Practice Address - Fax:630-628-5307
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist