Provider Demographics
NPI:1386766889
Name:AGOSTINELLI, JOSEPH R (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:AGOSTINELLI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 RICKERT DR STE 111
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8910
Mailing Address - Country:US
Mailing Address - Phone:630-364-4010
Mailing Address - Fax:833-305-0209
Practice Address - Street 1:1271 RICKERT DR STE 111
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8910
Practice Address - Country:US
Practice Address - Phone:630-364-4010
Practice Address - Fax:833-305-0209
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist