Provider Demographics
NPI:1053014100
Name:GEORGE, JEENA (PT, DPT)
Entity type:Individual
Prefix:
First Name:JEENA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5936 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3365
Mailing Address - Country:US
Mailing Address - Phone:847-440-6570
Mailing Address - Fax:
Practice Address - Street 1:1434 W US HIGHWAY 287 BYP STE 200
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5007
Practice Address - Country:US
Practice Address - Phone:469-553-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070027104225100000X
TX1401418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist