Provider Demographics
NPI:1144349002
Name:CHELETTE, ANITA T (P T)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:T
Last Name:CHELETTE
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:T
Other - Last Name:CHELETTE-CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:P T
Mailing Address - Street 1:2206 W CULLOM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1614
Mailing Address - Country:US
Mailing Address - Phone:773-267-3645
Mailing Address - Fax:
Practice Address - Street 1:600 N MCCLURG CT
Practice Address - Street 2:A312
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3044
Practice Address - Country:US
Practice Address - Phone:312-337-8840
Practice Address - Fax:312-337-9334
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist