Jenifer Carlos De Lara, PT

Primary specialty

Geriatric Physical TherapistTaxonomy code 2251G0304X

License

070-009035 Issued in IL

Practice address

1415 Sherman Ave
Apt. 605
Evanston, IL 60201-4453

Phone

(773) 817-2522

NPI assigned

Mar 9, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Direct Access Therapy, Inc

  • Physical Therapist
  • Oak Park, IL
  • NPI 1902072523
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268092800000",
    "number": "1255654950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 SHERMAN AVENUE #605",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "60201",
            "telephone_number": "773-817-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 SHERMAN AVE",
            "address_2": "APT. 605",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014453",
            "telephone_number": "773-817-2522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LARA",
        "first_name": "JENIFER",
        "middle_name": "CARLOS",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-09",
        "last_updated": "2010-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "IL",
            "license": "070-009035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Dayan, MD
• Salomon J Dayan, MD
• DDN Medical
• Erin De Groot, LCSW
• Audrone De la Vega, APN-CNP
• David De Leon, MD
• Ellen Deal
• Dean Prosthetic Orthotic SVC LTD
• Michael Debari, RPH
• Nicholas Xavier Decero

• Geriatric Physical Therapist in Evanston, IL
• Providers in Evanston, IL by specialty
• Geriatric Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.