Individual
JEROLD E DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, OCS
Contact information
Practice address
17517 80TH AVE, TINLEY PARK, IL 60477-6501
(708) 429-4814
(708) 429-9174
Mailing address
17517 80TH AVE, TINLEY PARK, IL 60477-6501
(708) 429-4814
(708) 429-9174
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
Primary
070006019
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070006019
LICENSE #
IL
01
—
1588773352
NPI
IL
Enumeration date
08/29/2006
Last updated
09/19/2019
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