Provider Demographics
NPI:1720735764
Name:JESSICA BRELJE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:JESSICA BRELJE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRELJE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-562-0907
Mailing Address - Street 1:4500 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-9600
Mailing Address - Country:US
Mailing Address - Phone:773-562-0907
Mailing Address - Fax:
Practice Address - Street 1:555 MICHAEL DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450
Practice Address - Country:US
Practice Address - Phone:773-562-0907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center