Provider Demographics
NPI: | 1154027977 |
---|---|
Name: | JKCATAHAY LLC |
Entity type: | Organization |
Organization Name: | JKCATAHAY LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/PHYSICAL THERAPIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JACQUELYN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CATAHAY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 312-508-8820 |
Mailing Address - Street 1: | 684 GREENBRIER LN |
Mailing Address - Street 2: | |
Mailing Address - City: | CRYSTAL LAKE |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60014-7011 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 312-508-8820 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 684 GREENBRIER LN |
Practice Address - Street 2: | |
Practice Address - City: | CRYSTAL LAKE |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60014-7011 |
Practice Address - Country: | US |
Practice Address - Phone: | 131-250-8882 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-02-02 |
Last Update Date: | 2024-01-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health | ||
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |