Provider Demographics
NPI:1871713115
Name:PALUSO-MILLER, JENNIFER LEE (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:PALUSO-MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:24014 W RENWICK RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-8708
Practice Address - Country:US
Practice Address - Phone:815-577-2488
Practice Address - Fax:815-577-2489
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013082L225100000X
FLPT20154225100000X
IL070015703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL568080OtherMEDICARE GROUP NUMBER
IN568150OtherMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP
IN567700OtherMEDICARE GROUP NUMBER
ILK48176Medicare PIN
IL1619908OtherBCBS IL GROUP
IN567700OtherMEDICARE GROUP NUMBER