Healthcare Provider Details

I. General information

NPI: 1912523341
Provider Name (Legal Business Name): DPT HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27401 W IL ROUTE 22, STE 107
BARRINGTON IL
60010-5934
US

IV. Provider business mailing address

24014 W RENWICK RD STE F
PLAINFIELD IL
60544-8708
US

V. Phone/Fax

Practice location:
  • Phone: 800-974-4378
  • Fax: 630-515-1536
Mailing address:
  • Phone: 800-974-4378
  • Fax: 630-515-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CINDY SULLIVAN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 800-974-4378