Provider Demographics
NPI:1235221805
Name:BOZEDAY, DANA (PT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BOZEDAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:337 75TH ST
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2366
Practice Address - Country:US
Practice Address - Phone:630-789-0004
Practice Address - Fax:630-789-0095
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623066OtherBCBS PROVIDER #
IL367885100OtherUS DEPT OF LABOR PROV.#
ILCJ8115OtherRR MEDICARE GRP#
IL1619980OtherBCBS OF IL
ILCJ4383OtherR.R. MEDICARE GRP#
ILCJ4383OtherR.R. MEDICARE GRP#
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILK31513Medicare PIN
ILK31512Medicare PIN
IL568080Medicare PIN
IL367885100OtherUS DEPT OF LABOR PROV.#
ILCJ8115OtherRR MEDICARE GRP#
ILR02575Medicare PIN
ILR02573Medicare PIN
IL1623066OtherBCBS PROVIDER #
IL568150Medicare PIN