Provider Demographics
NPI:1508897034
Name:ANDERSON, BARBARA ANN (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:ANDERSON
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 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:3865 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2424
Practice Address - Country:US
Practice Address - Phone:630-587-5788
Practice Address - Fax:630-587-8570
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherBCBS IL GROUP NUMBER
IL367885100OtherUS DEPT OF LABOR PROV.
IL1623066OtherBCBS PROVIDER NUMBER
IL202542Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILR03336Medicare PIN
IL568080Medicare PIN
IL1623066OtherBCBS PROVIDER NUMBER
IL1619908OtherBCBS IL GROUP NUMBER
IL367885100OtherUS DEPT OF LABOR PROV.
ILL96170Medicare PIN
IL567700Medicare PIN
ILR03335Medicare PIN