MEDICARE: MS. HEATHER L. DILLAVOU P.T.

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	225100000X	Physical Therapist	070010996	IL

General Provider Information

NPI Number	:	1972771228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER L. DILLAVOU P.T.

Provider Business Mailing Address
First Line	:	3232 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1106
Country	:	US
Telephone Number	:	773-525-1533
Fax Number	:	773-935-1755

Provider Business Practice Location Address
First Line	:	3232 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1106
Country	:	US
Telephone Number	:	773-525-1533
Fax Number	:	773-935-1755

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	10/25/2023

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