Healthcare Provider Details

I. General information

NPI: 1457600678
Provider Name (Legal Business Name): ADAM DOLA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8937 GRAND AVE
RIVER GROVE IL
60171-3603
US

IV. Provider business mailing address

625 ENTERPRISE DR.
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 708-453-1354
  • Fax: 708-453-2679
Mailing address:
  • Phone: 630-575-6250
  • Fax: 630-575-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-019461
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: