Provider Demographics
NPI:1275986523
Name:GEIS, JOLIEN
Entity Type:Individual
Prefix:
First Name:JOLIEN
Middle Name:
Last Name:GEIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:1701 N LARKIN AVE
Practice Address - Street 2:SUITE 606
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-1970
Practice Address - Country:US
Practice Address - Phone:815-893-8300
Practice Address - Fax:815-729-9105
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.007187225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant