Provider Demographics
NPI:1538678354
Name:DANESHDOOST, ANITA TALLEGIEN (PT, DPT, MS)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:TALLEGIEN
Last Name:DANESHDOOST
Suffix:
Gender:F
Credentials:PT, DPT, MS
Other - Prefix:DR
Other - First Name:ANITA
Other - Middle Name:TALLEGIEN
Other - Last Name:KEMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, MS
Mailing Address - Street 1:157 LILAC LANE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903
Mailing Address - Country:US
Mailing Address - Phone:618-521-4529
Mailing Address - Fax:
Practice Address - Street 1:1725 SHOMAKER DRIVE
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966
Practice Address - Country:US
Practice Address - Phone:618-684-2109
Practice Address - Fax:618-687-1638
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0069312251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics