Organization
MELISSA JACOB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENT G LATTANZI (HUMAN RESOURCE ASSISTANT)
(410) 667-7200
Entity
Organization
Contact information
Practice address
420 N WOLF RD, NORTHLAKE, IL 60164-1670
(708) 562-4300
Mailing address
3N464 PATRICIA LN, ELMHURST, IL 60126-1210
(630) 850-0994
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
070022999
IL
Other
Enumeration date
03/20/2018
Last updated
04/17/2018
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