Organization
JESSE BROWN VA MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN LLAMAS (PHYSICAL THERAPIST)
(708) 889-0599
Entity
Organization
Contact information
Practice address
820 S DAMEN AVE, CHICAGO, IL 60612-3728
(312) 569-6399
Mailing address
17732 EXCHANGE AVE, LANSING, IL 60438-4804
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
05008375A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
161684
NPI ENUMERATOR NUMBER
IL
Enumeration date
06/08/2006
Last updated
08/22/2020
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