Provider Demographics
NPI:1619382678
Name:RICHARDSON, JANA (PT, DPT, WCS, PRPC)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PT, DPT, WCS, PRPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S COUNTY FARM RD STE H
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4523
Mailing Address - Country:US
Mailing Address - Phone:773-219-2749
Mailing Address - Fax:773-897-0087
Practice Address - Street 1:301 S COUNTY FARM RD STE H
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4523
Practice Address - Country:US
Practice Address - Phone:773-219-2749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-020664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist