Provider Demographics
NPI:1366518839
Name:VECHAZONE, BO JAY (PT)
Entity type:Individual
Prefix:
First Name:BO
Middle Name:JAY
Last Name:VECHAZONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BERNARD
Other - Middle Name:JAY
Other - Last Name:VECHAZONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:1749 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-2857
Practice Address - Country:US
Practice Address - Phone:248-987-8947
Practice Address - Fax:248-653-6695
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist