Provider Demographics
NPI:1558149971
Name:DUSIK VARGAS, EDDIE ANTHONY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:ANTHONY
Last Name:DUSIK VARGAS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 S MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-1021
Mailing Address - Country:US
Mailing Address - Phone:773-851-8269
Mailing Address - Fax:
Practice Address - Street 1:2569 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3147
Practice Address - Country:US
Practice Address - Phone:773-252-4921
Practice Address - Fax:773-252-5067
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.027729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist