Individual
CHAREDE ANGDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1044 N FRANCISCO AVE, CHICAGO, IL 60622-2743
(773) 292-8354
Mailing address
3632 N WESTERN AVE, CHICAGO, IL 60618-4715
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11011960
I DO NOT HAVE ANY OTHER ID NO. I AM JUST APPLYING FOR AN NPI#
—
Enumeration date
04/04/2019
Last updated
04/04/2019
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