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General NPI Number Information
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NPI Number | 1861247017
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Entity Type | Individual
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Provider Name | JOEL LISEN PT
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Gender | Male
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 5525 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629-4400
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Country | US
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Telephone | 866-600-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 1333 S WABASH AVE UNIT 1803
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City | CHICAGO
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State | IL
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Zip | 60605-2628
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Country | US
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Telephone | 772-532-0624
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 26241
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070028189
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License Number State | IL
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