Provider Demographics
NPI:1477446862
Name:EDWARDS, DYLAN (DPT)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:X
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2164
Mailing Address - Country:US
Mailing Address - Phone:847-793-1072
Mailing Address - Fax:
Practice Address - Street 1:412 E BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2164
Practice Address - Country:US
Practice Address - Phone:847-793-1072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
070028510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist