Provider Demographics
NPI:1881020378
Name:JLI LC
Entity Type:Organization
Organization Name:JLI LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-990-1990
Mailing Address - Street 1:11075 S STATE ST
Mailing Address - Street 2:BLDG. 35
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5164
Mailing Address - Country:US
Mailing Address - Phone:801-990-1990
Mailing Address - Fax:
Practice Address - Street 1:11075 S STATE ST
Practice Address - Street 2:BLDG. 35
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5164
Practice Address - Country:US
Practice Address - Phone:801-990-1990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2780612401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty