Basic Information
| Provider Information | |||||||||
| NPI: | 1871749275 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DARRAGH | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | PT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 W WACKER DR | ||||||||
| Address2: | SUITE 1020 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606061216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126400329 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2555 LINCOLN HWY | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | OLYMPIA FIELDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604611936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084812323 | ||||||||
| FaxNumber: | 7084813311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2008 | ||||||||
| LastUpdateDate: | 12/10/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070-015787 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2255A2300X | 096-001739 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.