Provider Demographics
NPI:1093886582
Name:COE, DOLORES DIANNE (P T)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:DIANNE
Last Name:COE
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1120
Mailing Address - Country:US
Mailing Address - Phone:847-516-1842
Mailing Address - Fax:
Practice Address - Street 1:525 E CONGRESS PKWY STE 210
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6258
Practice Address - Country:US
Practice Address - Phone:847-842-4846
Practice Address - Fax:815-455-9359
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist