Provider Demographics
NPI:1497950471
Name:DAUSMAN, MARY LYNN (PT,)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:DAUSMAN
Suffix:
Gender:F
Credentials:PT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 N LONDON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4432
Mailing Address - Country:US
Mailing Address - Phone:815-398-6279
Mailing Address - Fax:
Practice Address - Street 1:2550 CHARLES ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1673
Practice Address - Country:US
Practice Address - Phone:815-391-7550
Practice Address - Fax:815-391-7551
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist