Provider Demographics
NPI:1083362495
Name:MANKO, DOMINIKA (DPT)
Entity Type:Individual
Prefix:
First Name:DOMINIKA
Middle Name:
Last Name:MANKO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 INWOOD DR APT 404
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-6725
Mailing Address - Country:US
Mailing Address - Phone:224-616-0283
Mailing Address - Fax:
Practice Address - Street 1:1614 W CENTRAL RD STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2453
Practice Address - Country:US
Practice Address - Phone:607-748-1847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist