Healthcare Provider Details

I. General information

NPI: 1255110680
Provider Name (Legal Business Name): EMILY DYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 BELMONT LN
CAROL STREAM IL
60188-2467
US

IV. Provider business mailing address

698 NAPA LN
SAINT CHARLES MO
63304-1444
US

V. Phone/Fax

Practice location:
  • Phone: 630-523-8972
  • Fax:
Mailing address:
  • Phone: 314-610-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070027771
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: