Basic Information
Provider Information
NPI: 1376977595
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOYA
FirstName: LAURA
MiddleName: Y
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 625 ENTERPRISE DR
Address2:  
City: OAK BROOK
State: IL
PostalCode: 605238813
CountryCode: US
TelephoneNumber: 6305751980
FaxNumber:  
Practice Location
Address1: 34572 N US HIGHWAY 45
Address2:  
City: THIRD LAKE
State: IL
PostalCode: 600304037
CountryCode: US
TelephoneNumber: 8475483695
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/23/2013
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X070-020211ILY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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