Provider Demographics
NPI:1871128553
Name:GEORGE, JITHIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JITHIN
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 N EASTLAND ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1706
Mailing Address - Country:US
Mailing Address - Phone:630-242-0174
Mailing Address - Fax:
Practice Address - Street 1:480 N WOLF RD
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:IL
Practice Address - Zip Code:60164-1650
Practice Address - Country:US
Practice Address - Phone:708-562-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.022407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist