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General NPI Number Information
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NPI Number | 1518085364
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Entity Type | Individual
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Provider Name | DIANE MAUK DAVIS P.T.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | UNIVERSITY OF CHICAGO HOSPITALS 5841 S. MARYLAND AVENUE
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City | CHICAGO
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State | IL
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Zip | 60637
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Country | US
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Telephone | 773-702-6926
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Fax | 773-702-5340
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Provider Business Mailing Address
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Address Line | 777 N MICHIGAN AVE 3208
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City | CHICAGO
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State | IL
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Zip | 60611-2617
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Country | US
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Telephone | 312-337-1380
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Fax | 773-702-5340
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | IL
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