Provider Demographics
NPI:1437297363
Name:GREISS, JENNIFER JOURJY (MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOURJY
Last Name:GREISS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:JOURJY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035
Mailing Address - Country:US
Mailing Address - Phone:586-416-9100
Mailing Address - Fax:586-416-9103
Practice Address - Street 1:3501 S HARLEM AVE STE 1
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-4515
Practice Address - Country:US
Practice Address - Phone:847-818-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18523225100000X
IL070016787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00844072OtherMEDICARE RR
IL214708024Medicare PIN
IL212623014Medicare PIN
IL202845071Medicare PIN
IL216859038Medicare PIN
IL216860022Medicare PIN