Provider Demographics
NPI:1982746715
Name:JOLLEY, KARA M (MPT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:M
Last Name:JOLLEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:M
Other - Last Name:ROOTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:3155 W CRAIG RD STE 120140
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0782
Practice Address - Country:US
Practice Address - Phone:702-639-2333
Practice Address - Fax:702-639-2334
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202845308Medicare PIN
IL216859297Medicare PIN