Provider Demographics
NPI:1114036795
Name:TIU, JOHN (PT, CERTMDT, OCS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:TIU
Suffix:
Gender:M
Credentials:PT, CERTMDT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S CANAL ST APT 409
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3904
Mailing Address - Country:US
Mailing Address - Phone:312-715-0829
Mailing Address - Fax:
Practice Address - Street 1:130 S CANAL ST
Practice Address - Street 2:UNIT 409
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-3906
Practice Address - Country:US
Practice Address - Phone:312-926-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-008371OtherLICENSE #