Provider Demographics
NPI:1487082848
Name:BAKOS, JOANNA (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BAKOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4223 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2901
Mailing Address - Country:US
Mailing Address - Phone:773-661-2990
Mailing Address - Fax:773-661-2995
Practice Address - Street 1:4223 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-2901
Practice Address - Country:US
Practice Address - Phone:773-661-2990
Practice Address - Fax:773-661-2995
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT8715022251X0800X
IL070022988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic