Healthcare Provider Details

I. General information

NPI: 1699804294
Provider Name (Legal Business Name): DIANE DALY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6921 W ARCHER AVE
CHICAGO IL
60638-2319
US

IV. Provider business mailing address

5732 S MCVICKER AVE
CHICAGO IL
60638-3534
US

V. Phone/Fax

Practice location:
  • Phone: 773-586-2768
  • Fax: 773-586-2780
Mailing address:
  • Phone: 773-581-6273
  • Fax: 773-586-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: