Provider Demographics
NPI:1154622272
Name:TAN, JOSEPHINE BAYLOSIS (PT)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:BAYLOSIS
Last Name:TAN
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 1:11139 NORTHWEST RD
Mailing Address - Street 2:APT C
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-2155
Mailing Address - Country:US
Mailing Address - Phone:630-770-0657
Mailing Address - Fax:708-586-2270
Practice Address - Street 1:9401 RIDGELAND AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2221
Practice Address - Country:US
Practice Address - Phone:708-599-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist