Provider Demographics
NPI:1750483160
Name:INVERGO, JOSEPH J (RKT, MSED)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:INVERGO
Suffix:
Gender:M
Credentials:RKT, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WILSON CT
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1370
Mailing Address - Country:US
Mailing Address - Phone:708-481-6953
Mailing Address - Fax:
Practice Address - Street 1:5TH AVE & ROOSEVELT RD
Practice Address - Street 2:HINES VAMC
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist