MEDICARE: MR. DAMON DION RHINEHART PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172M00000X	Mechanotherapist	225200000X	IL

General Provider Information

NPI Number	:	1396019360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAMON DION RHINEHART PTA

Provider Business Mailing Address
First Line	:	5959 N KENMORE AVE
Second Line	:	APT 403
City	:	CHICAGO
State	:	IL
Zip	:	60660-5019
Country	:	US
Telephone Number	:	313-737-8064
Fax Number	:

Provider Business Practice Location Address
First Line	:	5959 N KENMORE AVE
Second Line	:	APT 403
City	:	CHICAGO
State	:	IL
Zip	:	60660-5019
Country	:	US
Telephone Number	:	313-737-8064
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	03/08/2012

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