Provider Demographics
NPI:1184776213
Name:ANOSEN, HARALD (PT)
Entity type:Individual
Prefix:MR
First Name:HARALD
Middle Name:
Last Name:ANOSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 GUNDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2150
Mailing Address - Country:US
Mailing Address - Phone:708-848-3059
Mailing Address - Fax:708-848-2061
Practice Address - Street 1:1185 GUNDERSON AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2150
Practice Address - Country:US
Practice Address - Phone:708-848-3059
Practice Address - Fax:708-848-2061
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001604547OtherBCBS PROVIDER #