Provider Demographics
NPI:1194069781
Name:KU, JAMES (DPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KU
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 1:2211 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1570
Mailing Address - Country:US
Mailing Address - Phone:847-267-8600
Mailing Address - Fax:847-267-9520
Practice Address - Street 1:2211 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1570
Practice Address - Country:US
Practice Address - Phone:847-267-8600
Practice Address - Fax:847-267-9520
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-019590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist