Provider Demographics
NPI:1518220011
Name:HARJU, NICHOLE (DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:HARJU
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 1:222 S GREENLEAF ST
Mailing Address - Street 2:STE 101
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5705
Mailing Address - Country:US
Mailing Address - Phone:847-599-9171
Mailing Address - Fax:
Practice Address - Street 1:4835 KINGS WAY W
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3257
Practice Address - Country:US
Practice Address - Phone:847-599-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist