Provider Demographics
NPI:1144460270
Name:BALOGUN, JOSEPH ABIODUN (PHD PT)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ABIODUN
Last Name:BALOGUN
Suffix:
Gender:M
Credentials:PHD PT
Other - Prefix:
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Mailing Address - Street 1:2 OLYMPUS DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4827
Mailing Address - Country:US
Mailing Address - Phone:708-420-3250
Mailing Address - Fax:708-429-5868
Practice Address - Street 1:2 OLYMPUS DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4827
Practice Address - Country:US
Practice Address - Phone:708-420-3250
Practice Address - Fax:708-429-5868
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-0111436225100000X, 2251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary