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NPI Code Detail

MEDICARE: DR. JOSEPH ABIODUN BALOGUN PHD PT

MEDICARE: DR. JOSEPH ABIODUN BALOGUN PHD PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070-0111436IL
22251C2600XCardiopulmonary Physical Therapist070-0111436IL

General Provider Information

NPI Number : 1144460270
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPH ABIODUN BALOGUN PHD PT
Provider Business Mailing Address
First Line : 2 OLYMPUS DR
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-4827
Country : US
Telephone Number : 708-420-3250
Fax Number : 708-429-5868
Provider Business Practice Location Address
First Line : 2 OLYMPUS DR
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-4827
Country : US
Telephone Number : 708-420-3250
Fax Number : 708-429-5868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2009
Last Update Date : 03/02/2009

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