Provider Demographics
NPI:1780784215
Name:CASPER, JOY ANDRUS (PT)
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:ANDRUS
Last Name:CASPER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 N NORTHWEST HWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1411
Mailing Address - Country:US
Mailing Address - Phone:847-298-7024
Mailing Address - Fax:847-298-7155
Practice Address - Street 1:1550 N NORTHWEST HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1411
Practice Address - Country:US
Practice Address - Phone:847-298-3079
Practice Address - Fax:847-298-4019
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL604530OtherPTAN LOCALITY 16
IL215827OtherPTNA LOCALITY 99