Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070011075 | IL |
N | 2251S0007X | Physical Therapist - Sports | 070011075 | IL |
N | 2251X0800X | Physical Therapist - Orthopedic | 070011075 | IL |
NPI | 1154494334 |
---|---|
Provider Name | Julie M Jachimek |
First Address | Chicago, IL 60674-1216 |
Second Address | Joliet, IL 60435-5487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 10/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1619908 | BCBS IL GROUP (01) | IL |
1620259 | BLUE CROSS BLUE SHIELD (01) | IL |
354400405001 | (05) | IL |
4429630 | AETNA (01) | IL |
568150 | MEDICARE GROUP NUMBER (01) | IL |
CD3789 | MEDICARE RAILROAD GROUP NUMBER (01) | IL |
P00623067 | MEDICARE RAILROAD NUMBER (01) | IL |