Healthcare Provider Details

I. General information

NPI: 1902162522
Provider Name (Legal Business Name): DEANA MARIE TOKARZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 PEARSON STREET. UNIT 407C
DES PLAINES IL
60016
US

IV. Provider business mailing address

656 PEARSON STREET. UNIT 407C
DES PLAINES IL
60016
US

V. Phone/Fax

Practice location:
  • Phone: 847-768-0491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.004097
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227002391
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: