Provider Demographics
NPI:1164738753
Name:SAULT, JOSIAH DANIEL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JOSIAH
Middle Name:DANIEL
Last Name:SAULT
Suffix:
Gender:M
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 1:350 W OAKDALE AVE APT 803
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5618
Mailing Address - Country:US
Mailing Address - Phone:630-209-5326
Mailing Address - Fax:
Practice Address - Street 1:1801 W TAYLOR ST # MC889
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4795
Practice Address - Country:US
Practice Address - Phone:312-355-4394
Practice Address - Fax:312-996-8739
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist