Provider Demographics
NPI:1861592909
Name:CLEARY, JEANNE PORTER (PT)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:PORTER
Last Name:CLEARY
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 1:6 E BURR OAK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1918
Mailing Address - Country:US
Mailing Address - Phone:847-670-7286
Mailing Address - Fax:
Practice Address - Street 1:1683 ELK BLVD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4721
Practice Address - Country:US
Practice Address - Phone:847-390-0999
Practice Address - Fax:847-390-0949
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL050-005000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK27447Medicare ID - Type UnspecifiedMCHENRY COUNTY
ILL92202Medicare ID - Type UnspecifiedCOOK COUNTY