Healthcare Provider Details

I. General information

NPI: 1972726313
Provider Name (Legal Business Name): DAMON R BESCIA DPT OCS SCS FAAOMPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 SKYLANE DR
NAPERVILLE IL
60564-9474
US

IV. Provider business mailing address

2140 SKYLANE DR
NAPERVILLE IL
60564-9474
US

V. Phone/Fax

Practice location:
  • Phone: 630-408-9703
  • Fax: 888-480-9020
Mailing address:
  • Phone: 630-408-9703
  • Fax: 888-480-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number70015648
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: