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General NPI Number Information
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NPI Number | 1023422151
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Entity Type | Individual
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Provider Name | VIRGINIA DORNIK MT
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Gender | Female
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 310 S GREENLEAF ST STE 208
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City | GURNEE
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State | IL
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Zip | 60031-5708
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Country | US
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Telephone | 224-214-3932
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Fax | 224-204-9354
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Provider Business Mailing Address
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Address Line | 310 S GREENLEAF ST STE 208
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City | GURNEE
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State | IL
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Zip | 60031-5708
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Country | US
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Telephone | 224-214-3932
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Fax | 224-204-9354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227000142
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License Number State | IL
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