Healthcare Provider Details

I. General information

NPI: 1972771228
Provider Name (Legal Business Name): HEATHER L. DILLAVOU P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3232 N LINCOLN AVE
CHICAGO IL
60657-1106
US

IV. Provider business mailing address

3232 N LINCOLN AVE
CHICAGO IL
60657-1106
US

V. Phone/Fax

Practice location:
  • Phone: 773-525-1533
  • Fax: 773-935-1755
Mailing address:
  • Phone: 773-525-1533
  • Fax: 773-935-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070010996
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: