Provider Demographics
NPI:1740584531
Name:INNES, JOANNE LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:LOUISE
Last Name:INNES
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:9 LEE AIRPARK DR
Practice Address - Street 2:SUITE 400
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1229
Practice Address - Country:US
Practice Address - Phone:443-607-1469
Practice Address - Fax:410-956-2618
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008928225100000X
MD26317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist