Provider Demographics
NPI:1700272051
Name:PELAEZ, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:PELAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 BOARDWALK BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-3775
Mailing Address - Country:US
Mailing Address - Phone:630-765-1444
Mailing Address - Fax:
Practice Address - Street 1:2547 BOARDWALK BLVD APT C
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-3775
Practice Address - Country:US
Practice Address - Phone:630-765-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist