Provider Demographics
NPI:1770649899
Name:KLASEN, JOHN T (JOHN KLASEN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:KLASEN
Suffix:
Gender:M
Credentials:JOHN KLASEN
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:T
Other - Last Name:KLASEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JOHN KLASEN
Mailing Address - Street 1:1412 N DUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4729
Mailing Address - Country:US
Mailing Address - Phone:847-259-5981
Mailing Address - Fax:
Practice Address - Street 1:1412 N DUNTON AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4729
Practice Address - Country:US
Practice Address - Phone:847-259-5981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist