Provider Demographics
NPI:1518154053
Name:TAN, ROY JONSON (PT)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:JONSON
Last Name:TAN
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 1:6263 FREMONT DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-4948
Mailing Address - Country:US
Mailing Address - Phone:630-770-0634
Mailing Address - Fax:630-540-1296
Practice Address - Street 1:6263 FREMONT DR
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-4948
Practice Address - Country:US
Practice Address - Phone:630-770-0634
Practice Address - Fax:630-540-1296
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist