Joseph Donayre Fadullon, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501007885 Issued in MI

Practice address

386 Clubhouse St
Bolingbrook, IL 60490-2119

Phone

(906) 748-0183

Fax

(630) 759-6873

NPI assigned

Feb 13, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Body Mechanix Physical Therapy of Marquette, LLC

  • Physical Therapist
  • Marquette, MI
  • NPI 1700974623
  NPD (past)
• Up Rehab Services LLC

  • Physical Therapist
  • Kingsford, MI
  • NPI 1821148529
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187568000000",
    "number": "1386786432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "386 CLUBHOUSE ST",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604902119",
            "telephone_number": "906-748-0183",
            "fax_number": "630-759-6873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "386 CLUBHOUSE ST",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604902119",
            "telephone_number": "906-748-0183",
            "fax_number": "630-759-6873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADULLON",
        "first_name": "JOSEPH",
        "middle_name": "DONAYRE",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2007-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501007885",
            "primary": true
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "MI",
            "license": "5501007885",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanne Evans-Smith, OT
• Everwell Wound Care, P.C.
• Evolve Nurse Consultant Services
• Express Care Enterprises
• Eyezone Eyecare, Inc.
• Canan Fairhurst
• Fairhurstcare LLC
• Ana Fajardo, LCSW
• Family Doctor Now PLLC
• Family Eye Care of Bolingbrook LTD

• Physical Therapist in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.