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General NPI Number Information
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NPI Number | 1487775599
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Entity Type | Organization
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Legal Business Name | DYNAMIC EASE LLC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 3424 N DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60618-6106
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Country | US
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Telephone | 773-248-2288
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Fax | 773-248-2282
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Provider Business Mailing Address
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Address Line | 3424 N DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60618-6106
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Country | US
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Telephone | 773-248-2288
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Fax | 773-248-2282
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Authorized Official
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Title or Position | OWNER
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Name | KERRY ANNE DONTCHOS
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Credential | PT
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Telephone | 773-248-2288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 070009968
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License Number State | IL
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