Provider Demographics
NPI:1538296975
Name:BRELJE, JESSICA (MPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BRELJE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:KIELHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:1036 W US ROUTE 6
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-8942
Practice Address - Country:US
Practice Address - Phone:815-416-1049
Practice Address - Fax:815-416-1040
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207067022Medicare PIN