Provider Demographics
NPI:1689607368
Name:PRO-MOTION PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PRO-MOTION PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUTCLIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:815-521-4400
Mailing Address - Street 1:1010 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-8810
Mailing Address - Country:US
Mailing Address - Phone:815-521-4400
Mailing Address - Fax:815-521-9709
Practice Address - Street 1:1010 S RIDGE RD
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-8810
Practice Address - Country:US
Practice Address - Phone:815-521-4400
Practice Address - Fax:815-521-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9932202OtherBLUE CROSS/BLUE SHIELD
IL209644Medicare ID - Type Unspecified