Provider Demographics
NPI:1184238842
Name:JOE, JA'NISA LATOYA (PT, DPT)
Entity type:Individual
Prefix:
First Name:JA'NISA
Middle Name:LATOYA
Last Name:JOE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JA'NISA
Other - Middle Name:
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
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:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:833 SAINT VINCENTS DR UNIT 1
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1606
Practice Address - Country:US
Practice Address - Phone:205-730-3190
Practice Address - Fax:205-666-7170
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist