Healthcare Provider Details

I. General information

NPI: 1124221254
Provider Name (Legal Business Name): ANN COLLEEN NASVYTIS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON AVE
WHEATON IL
60189-6833
US

IV. Provider business mailing address

1509 WILSON AVE
WHEATON IL
60189-6833
US

V. Phone/Fax

Practice location:
  • Phone: 312-307-2339
  • Fax:
Mailing address:
  • Phone: 312-307-2339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070014113
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40093
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050586
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1378459
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22185
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6738
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: