Provider Demographics
NPI:1619860319
Name:JOHN, JILU (PT)
Entity type:Individual
Prefix:
First Name:JILU
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 N 1ST ST # NA
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2822
Mailing Address - Country:US
Mailing Address - Phone:678-467-2578
Mailing Address - Fax:516-555-1234
Practice Address - Street 1:246 JERICHO TPKE # NA
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2147
Practice Address - Country:US
Practice Address - Phone:516-531-7879
Practice Address - Fax:516-773-7315
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist