Healthcare Provider Details

I. General information

NPI: 1720224272
Provider Name (Legal Business Name): DAWN GARCIA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 HARRISON ST
BELLWOOD IL
60104-2450
US

IV. Provider business mailing address

2615 HARRISON ST
BELLWOOD IL
60104-2450
US

V. Phone/Fax

Practice location:
  • Phone: 708-493-0199
  • Fax: 708-493-9683
Mailing address:
  • Phone: 708-493-0199
  • Fax: 708-493-9683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160004372
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number160004372
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: