Healthcare Provider Details

I. General information

NPI: 1306262720
Provider Name (Legal Business Name): ALLISON KAY DILLENBURG PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON VLIETSTRA

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 RANDALL RD
SOUTH ELGIN IL
60177-3315
US

IV. Provider business mailing address

230 LAKESIDE CT APT 1111
ST CHARLES IL
60174-7925
US

V. Phone/Fax

Practice location:
  • Phone: 630-315-6880
  • Fax:
Mailing address:
  • Phone: 630-315-6882
  • Fax: 630-315-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070020587
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number112057
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: