Provider Demographics
NPI:1275196248
Name:JOO, GRACE (DPT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:JOO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 S COUNTY LINE RD STE 57
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8132
Mailing Address - Country:US
Mailing Address - Phone:630-230-9565
Mailing Address - Fax:630-581-5462
Practice Address - Street 1:6101 S COUNTY LINE RD STE 57
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-8132
Practice Address - Country:US
Practice Address - Phone:630-230-9565
Practice Address - Fax:630-581-5462
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070024252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist