Provider Demographics
NPI:1750514204
Name:DEGREGORIO, JOLISE (PT)
Entity type:Individual
Prefix:
First Name:JOLISE
Middle Name:
Last Name:DEGREGORIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S BRIGGS ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60433-9591
Mailing Address - Country:US
Mailing Address - Phone:815-722-1757
Mailing Address - Fax:815-722-1767
Practice Address - Street 1:211 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1696
Practice Address - Country:US
Practice Address - Phone:708-709-6535
Practice Address - Fax:708-709-6252
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-017322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist