Provider Demographics
NPI:1518085364
Name:DAVIS, DIANE MAUK (PT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MAUK
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:777 N MICHIGAN AVE
Mailing Address - Street 2:3208
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2617
Mailing Address - Country:US
Mailing Address - Phone:312-337-1380
Mailing Address - Fax:773-702-5340
Practice Address - Street 1:UNIVERSITY OF CHICAGO HOSPITALS
Practice Address - Street 2:5841 S. MARYLAND AVENUE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-702-6926
Practice Address - Fax:773-702-5340
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist