Healthcare Provider Details

I. General information

NPI: 1811321995
Provider Name (Legal Business Name): THOMAS J DYKE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 12/20/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 W IRVING PARK RD STE 1A
CHICAGO IL
60641-2828
US

IV. Provider business mailing address

4323 W IRVING PARK RD STE 1A
CHICAGO IL
60641-2828
US

V. Phone/Fax

Practice location:
  • Phone: 773-930-3087
  • Fax:
Mailing address:
  • Phone: 773-930-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070020171
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 60531867
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: