Provider Demographics
NPI:1538486220
Name:JURCIKONIENE, GRETA
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:JURCIKONIENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W PLEASANT HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-6851
Mailing Address - Country:US
Mailing Address - Phone:224-522-7474
Mailing Address - Fax:
Practice Address - Street 1:325 W PLEASANT HILL BLVD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-6851
Practice Address - Country:US
Practice Address - Phone:224-522-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227002107225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist