Provider Demographics
NPI:1124221254
Name:NASVYTIS, ANN COLLEEN (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:COLLEEN
Last Name:NASVYTIS
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 1:11 ERVEN RD
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-9303
Mailing Address - Country:US
Mailing Address - Phone:312-307-2339
Mailing Address - Fax:
Practice Address - Street 1:11 ERVEN RD
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-9303
Practice Address - Country:US
Practice Address - Phone:312-307-2339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40093225100000X
TX1378459225100000X
NY050586225100000X
FL22185225100000X
MSPT6738225100000X
IL070014113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist