Provider Demographics
NPI:1326352899
Name:DE JESUS, SANDRA MARIA (PT,DPT)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MARIA
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 N. HARLEM AVENUE
Mailing Address - Street 2:214
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3194
Mailing Address - Country:US
Mailing Address - Phone:773-848-4846
Mailing Address - Fax:
Practice Address - Street 1:3630 N. HARLEM AVENUE
Practice Address - Street 2:214
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3194
Practice Address - Country:US
Practice Address - Phone:773-848-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700158552251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics