Provider Demographics
NPI:1649927963
Name:JOSEPH, MANNU JAMES (PT)
Entity type:Individual
Prefix:
First Name:MANNU
Middle Name:JAMES
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MANNU
Other - Middle Name:
Other - Last Name:THIRUNELLIPARAMBIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2061 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6617
Mailing Address - Country:US
Mailing Address - Phone:847-571-7572
Mailing Address - Fax:
Practice Address - Street 1:707 LAKE COOK RD STE 120
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4909
Practice Address - Country:US
Practice Address - Phone:847-858-5172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty