Active NPI
Jana Marlene Susie, MSPT
- Pediatric Physical Therapist
- Winnetka, IL
National Provider Identifier
1184748220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 070.013558
- Practice address
- 1308 Forest Glen Dr S
Winnetka, IL 60093-1428 - Phone
- (773) 791-1397
- NPI assigned
- Mar 16, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 070.013558 | IL | Primary |
Addresses
Primary practice location
1308 Forest Glen Dr S
Winnetka, IL 60093-1428
Mailing address
1308 Forest Glen Dr S
Winnetka, IL 60093-1428
Phone (773) 791-1397
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.013558 | IL | MD | Pediatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Loop Pediatric Therapy LLC | Pediatrics | Past | Accepting new patients |
| Tobogo Therapies, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676937600000",
"number": "1184748220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1308 FOREST GLEN DR S",
"city": "WINNETKA",
"state": "IL",
"postal_code": "600931428",
"telephone_number": "773-791-1397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1308 FOREST GLEN DR S",
"city": "WINNETKA",
"state": "IL",
"postal_code": "600931428",
"telephone_number": "773-791-1397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUSIE",
"first_name": "JANA",
"middle_name": "MARLENE",
"name_prefix": "Mrs.",
"credential": "MSPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-16",
"last_updated": "2023-02-21",
"certification_date": "2023-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "IL",
"license": "070.013558",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winnetka, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.