Provider Demographics
NPI:1396019360
Name:RHINEHART, DAMON DION (PTA)
Entity Type:Individual
Prefix:MR
First Name:DAMON
Middle Name:DION
Last Name:RHINEHART
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 N KENMORE AVE
Mailing Address - Street 2:APT 403
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-5019
Mailing Address - Country:US
Mailing Address - Phone:313-737-8064
Mailing Address - Fax:
Practice Address - Street 1:5959 N KENMORE AVE
Practice Address - Street 2:APT 403
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-5019
Practice Address - Country:US
Practice Address - Phone:313-737-8064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist