Provider Demographics
NPI:1194060608
Name:JACOME, OSCAR (DPT)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:JACOME
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3624
Mailing Address - Country:US
Mailing Address - Phone:773-463-0249
Mailing Address - Fax:773-463-0733
Practice Address - Street 1:2837 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3624
Practice Address - Country:US
Practice Address - Phone:773-463-0249
Practice Address - Fax:773-463-0733
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-019596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist