Active NPI
Vanessa Jameson, DPT
- Physical Therapist
- Crystal Lake, IL
National Provider Identifier
1770157208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070025354
- Practice address
- 420 North Illinois Route 31
Crystal Lake, IL 60014 - Phone
- (815) 788-2000
- Fax
- (815) 788-8566
- NPI assigned
- May 19, 2021
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070025354 | IL | Primary |
Addresses
Primary practice location
420 North Illinois Route 31
Crystal Lake, IL 60014
Mailing address
1599 Stockton LN
Crystal Lake, IL 60014-2024
Phone (815) 814-5443
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 |
|---|---|---|---|
| 070025354 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621382400000",
"number": "1770157208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1599 STOCKTON LN",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600142024",
"telephone_number": "815-814-5443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 NORTH ILLINOIS ROUTE 31",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "60014",
"telephone_number": "815-788-2000",
"fax_number": "815-788-8566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAMESON",
"first_name": "VANESSA",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-19",
"last_updated": "2021-05-19",
"certification_date": "2021-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070025354",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.