Provider Demographics
NPI:1457443152
Name:ANDERSON, JOEL A (PT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:A
Last Name:ANDERSON
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 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:1776 W CENTENNIAL PL
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1075
Practice Address - Country:US
Practice Address - Phone:630-953-0343
Practice Address - Fax:630-953-0353
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
214708002Medicare PIN
ILK45270Medicare PIN
ILP00651129Medicare PIN
ILK27474Medicare PIN
ILP00651129Medicare PIN