Provider Demographics
NPI:1366715955
Name:MOHORIC, JESSE (PT)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:MOHORIC
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:260 BEISER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7790
Practice Address - Country:US
Practice Address - Phone:302-741-0200
Practice Address - Fax:302-741-0245
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002819225100000X
MD24762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP01055676OtherMEDICARE RAILROAD
MD348323ZGE2Medicare PIN
DEP01055676OtherMEDICARE RAILROAD