Provider Demographics
NPI:1750635256
Name:DELOS REYES, JAMIE
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:DELOS REYES
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 1:7938 STEWART DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5930
Mailing Address - Country:US
Mailing Address - Phone:630-674-0250
Mailing Address - Fax:
Practice Address - Street 1:7938 STEWART DR
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-5930
Practice Address - Country:US
Practice Address - Phone:630-674-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005274225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant