Provider Demographics
NPI:1679770143
Name:ANDERSON, JOAN MAREE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:MAREE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 PARK LN
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-1423
Mailing Address - Country:US
Mailing Address - Phone:847-991-1537
Mailing Address - Fax:847-577-0914
Practice Address - Street 1:885 PARK LN
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-1423
Practice Address - Country:US
Practice Address - Phone:847-991-1537
Practice Address - Fax:847-577-0914
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant