Healthcare Provider Details

I. General information

NPI: 1023789393
Provider Name (Legal Business Name): DANIEL DAGNINO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2021
Last Update Date: 06/07/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 N CREEK PLAZA
JOLIET IL
60435-2871
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-967-2000
  • Fax: 630-886-7821
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070026289
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: