Provider Demographics
NPI:1548272412
Name:ANALUISA, JENNY ANN MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:ANN MARIE
Last Name:ANALUISA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JENNY
Other - Middle Name:ANN MARIE
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2116 W NORTH AVE
Mailing Address - Street 2:APT 1N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5433
Mailing Address - Country:US
Mailing Address - Phone:404-272-4080
Mailing Address - Fax:
Practice Address - Street 1:EAST 65TH ST AT LAKE MICHIGAN
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649
Practice Address - Country:US
Practice Address - Phone:404-272-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8899843Medicaid