Provider Demographics
NPI:1013199520
Name:DIONELA, PETER (PT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:DIONELA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5504
Mailing Address - Country:US
Mailing Address - Phone:815-578-9655
Mailing Address - Fax:815-578-9642
Practice Address - Street 1:319 FRONT ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5504
Practice Address - Country:US
Practice Address - Phone:815-578-9655
Practice Address - Fax:815-578-9642
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00468079Medicare PIN
ILK47650Medicare PIN