Provider Demographics
NPI:1770771156
Name:NEBRIJA, JESSICA LARA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LARA
Last Name:NEBRIJA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:LAPASARAN-NEBRIJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12021 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1139
Mailing Address - Country:US
Mailing Address - Phone:708-923-1768
Mailing Address - Fax:708-923-1773
Practice Address - Street 1:12021 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1139
Practice Address - Country:US
Practice Address - Phone:708-923-1768
Practice Address - Fax:708-923-1773
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014869225100000X
225100000X
IN05008838A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist