Provider Demographics
NPI:1366546350
Name:DIMMER, JESSICA L (MPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:DIMMER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:RUMAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:919-296-1686
Mailing Address - Fax:
Practice Address - Street 1:2820 W ARMITAGE AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6318
Practice Address - Country:US
Practice Address - Phone:773-394-0796
Practice Address - Fax:773-394-3342
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012425225100000X
CA33682225100000X
IL070016193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherBCBS IL GROUP
IL568150OtherMEDICARE GROUP NUMBER
650E018390OtherBCBSM
IL567700OtherMEDICARE GROUP NUMBER
IL568080OtherMEDICARE GROUP NUMBER
IL567700OtherMEDICARE GROUP NUMBER
0P09750Medicare ID - Type UnspecifiedGROUP