Healthcare Provider Details

I. General information

NPI: 1225986821
Provider Name (Legal Business Name): JACOB PATTERSON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 W 95TH ST STE B6
OAK LAWN IL
60453-2546
US

IV. Provider business mailing address

4710 W 95TH ST STE B6
OAK LAWN IL
60453-2546
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-2960
  • Fax:
Mailing address:
  • Phone: 708-422-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.029796
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: