MEDICARE: DAVID RICHARD GHENA DHSC PT SCS ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00007154	WA
2	225100000X	Physical Therapist	5501005458	MI
3	225100000X	Physical Therapist		AZ
4	225100000X	Physical Therapist		IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770531311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID RICHARD GHENA DHSC PT SCS ATC

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20320 N JOHN WAYNE PKWY STE 120
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85139-2936
Country	:	US
Telephone Number	:	520-635-2260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	10/28/2025

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