Provider Demographics
NPI:1477724631
Name:JOURAS, THEMI (PT)
Entity Type:Individual
Prefix:MR
First Name:THEMI
Middle Name:
Last Name:JOURAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5703
Mailing Address - Country:US
Mailing Address - Phone:708-424-4047
Mailing Address - Fax:708-424-4591
Practice Address - Street 1:4114 SW HIGHWAY
Practice Address - Street 2:
Practice Address - City:HOMETOWN
Practice Address - State:IL
Practice Address - Zip Code:60456
Practice Address - Country:US
Practice Address - Phone:708-424-4047
Practice Address - Fax:708-424-4591
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070006524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL131945200OtherDEPT OF LABOR
IL350605988001Medicaid