Provider Demographics
NPI:1962503557
Name:CARONIA, ANTHONY R (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:CARONIA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:2124 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7514
Practice Address - Country:US
Practice Address - Phone:630-967-2000
Practice Address - Fax:331-551-5418
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00651060Medicare PIN
ILK53171Medicare PIN
ILK14388Medicare PIN
ILK53170Medicare PIN
ILP00438894Medicare PIN