Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070003791 | IL |
N | 2251E1200X | Ergonomics | 070-003791 | IL |
N | 225XE1200X | Ergonomics | 070-003791 | IL |
N | 2251G0304X | Physical Therapist - Geriatrics | 070-003791 | IL |
N | 2251H1300X | Human Factors | 070-003791 | IL |
N | 225XH1300X | Human Factors | 070-003791 | IL |
N | 2251N0400X | Physical Therapist - Neurology | 070-003791 | IL |
N | 2251P0200X | Physical Therapist - Pediatrics | 070-003791 | IL |
N | 2251S0007X | Physical Therapist - Sports | 070-003791 | IL |
N | 2251X0800X | Physical Therapist - Orthopedic | 070-003791 | IL |
NPI | 1669632121 |
---|---|
Provider Name | Mr. Timothy John Caruso |
First Address | Addison, IL 60101-1930 |
Second Address | Addison, IL 60101-5625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 09/06/2008 |