Provider Demographics
NPI:1700988250
Name:HASEMAN, ANNE (PT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:HASEMAN
Suffix:
Gender:F
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:PO BOX 1723
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60039-1723
Mailing Address - Country:US
Mailing Address - Phone:815-356-7680
Mailing Address - Fax:815-356-7864
Practice Address - Street 1:95 S MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6043
Practice Address - Country:US
Practice Address - Phone:815-353-2411
Practice Address - Fax:224-333-6710
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-004170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0005683004OtherBLUE CROSS/BLUE SHIELD