Provider Demographics
NPI:1740474758
Name:PECULIS, LORI JO
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JO
Last Name:PECULIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:JO
Other - Last Name:LINKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2846 W ESTES AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2904
Mailing Address - Country:US
Mailing Address - Phone:773-761-5434
Mailing Address - Fax:
Practice Address - Street 1:2846 W ESTES AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-2904
Practice Address - Country:US
Practice Address - Phone:773-761-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist