Provider Demographics
NPI:1740224070
Name:SAYSON, JOSELITO V (PT)
Entity Type:Individual
Prefix:
First Name:JOSELITO
Middle Name:V
Last Name:SAYSON
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 1:840 REVERE ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-4570
Mailing Address - Country:US
Mailing Address - Phone:815-933-4291
Mailing Address - Fax:
Practice Address - Street 1:586 WILLIAM LATHAM DR
Practice Address - Street 2:SUITE 3
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2327
Practice Address - Country:US
Practice Address - Phone:815-936-1992
Practice Address - Fax:815-936-0940
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL598350Medicare PIN
IL598350Medicare ID - Type UnspecifiedMEDICARE ID #