Provider Demographics
NPI:1629180922
Name:DAMITZ, TYSON S (DPT)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:S
Last Name:DAMITZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:312-640-0407
Practice Address - Street 1:8235 E 116TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1534
Practice Address - Country:US
Practice Address - Phone:317-813-2100
Practice Address - Fax:317-467-5701
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN99021235A225100000X
IN05008972A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist