Provider Demographics
NPI:1003693938
Name:CASILLAS, JOSHUA (PT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:CASILLAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 S MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5039
Mailing Address - Country:US
Mailing Address - Phone:224-735-1991
Mailing Address - Fax:
Practice Address - Street 1:229 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1179
Practice Address - Country:US
Practice Address - Phone:630-866-1074
Practice Address - Fax:630-866-1075
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.027721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist