Provider Demographics
NPI:1033865662
Name:JOSEPH, MALHERBE JOEY (PTA)
Entity Type:Individual
Prefix:MR
First Name:MALHERBE
Middle Name:JOEY
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15619 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-2732
Mailing Address - Country:US
Mailing Address - Phone:708-953-9190
Mailing Address - Fax:
Practice Address - Street 1:15619 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-2732
Practice Address - Country:US
Practice Address - Phone:708-953-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.008889225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant