Healthcare Provider Details

I. General information

NPI: 1033774880
Provider Name (Legal Business Name): JAMIE LEE PLACKETT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 VILLAGE OFFICE PL
CHAMPAIGN IL
61822-7673
US

IV. Provider business mailing address

24W321 HEMLOCK LN
NAPERVILLE IL
60540-9448
US

V. Phone/Fax

Practice location:
  • Phone: 217-841-0352
  • Fax:
Mailing address:
  • Phone: 217-841-0352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070025044
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: