Provider Demographics
NPI:1912170804
Name:JOSEPH, REJANI MARY (PT,DPT)
Entity Type:Individual
Prefix:
First Name:REJANI
Middle Name:MARY
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34281 N HAVERTON DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4281
Mailing Address - Country:US
Mailing Address - Phone:443-386-5617
Mailing Address - Fax:
Practice Address - Street 1:1288 STONEHAVEN CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8409
Practice Address - Country:US
Practice Address - Phone:877-258-1576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22264225100000X
IL070.019842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist