Provider Demographics
NPI:1275139727
Name:JOSEPH, JAISINE (PT)
Entity Type:Individual
Prefix:
First Name:JAISINE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 E GLADYS AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1948
Mailing Address - Country:US
Mailing Address - Phone:630-272-0371
Mailing Address - Fax:
Practice Address - Street 1:8434 CORCORAN RD
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-1666
Practice Address - Country:US
Practice Address - Phone:708-204-6706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070025357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist