Individual
JAMIESON T CREDILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1513 DEKALB AVE, SYCAMORE, IL 60178-2703
(815) 758-0000
(815) 991-9484
Mailing address
1952 ABERDEEN CT, SYCAMORE, IL 60178-3175
(815) 991-2333
(815) 748-3014
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070023046
PHYSICAL THERAPIST LICENSE
IL
Enumeration date
08/17/2017
Last updated
08/17/2017
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