Active NPI
Marie Jarell-Gracious, PT
- Physical Therapist
- New Lenox, IL
National Provider Identifier
1952326720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070-005355
- Practice address
- 701 Vanderbilt Dr
New Lenox, IL 60451-3826 - Phone
- (708) 359-1989
- NPI assigned
- Jul 13, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 070-005355 | IL | Primary |
Addresses
Primary practice location
701 Vanderbilt Dr
New Lenox, IL 60451-3826
Mailing address
701 Vanderbilt Dr
New Lenox, IL 60451-3826
Phone (708) 359-1989
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1623066 | Other | IL | BCBS PROVIDER NUMBER |
| 367885100 | Other | IL | US DEPT OF LABOR |
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 |
|---|---|---|---|
| 070-005355 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356566400000",
"number": "1952326720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 VANDERBILT DR",
"city": "NEW LENOX",
"state": "IL",
"postal_code": "604513826",
"telephone_number": "708-359-1989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 VANDERBILT DR",
"city": "NEW LENOX",
"state": "IL",
"postal_code": "604513826",
"telephone_number": "708-359-1989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JARELL-GRACIOUS",
"first_name": "MARIE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-13",
"last_updated": "2012-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070-005355",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "1623066",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "US DEPT OF LABOR",
"identifier": "367885100",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Lenox, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.