Healthcare Provider Details

I. General information

NPI: 1477724631
Provider Name (Legal Business Name): THEMI JOURAS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4114 SW HIGHWAY
HOMETOWN IL
60456
US

IV. Provider business mailing address

4004 W 111TH ST
OAK LAWN IL
60453-5703
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-4047
  • Fax: 708-424-4591
Mailing address:
  • Phone: 708-424-4047
  • Fax: 708-424-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070006524
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: