Provider Demographics
NPI:1659413961
Name:VON HOLTEN, DEEANNA (MPT)
Entity Type:Individual
Prefix:
First Name:DEEANNA
Middle Name:
Last Name:VON HOLTEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:25445 S PHEASANT LN
Practice Address - Street 2:UNIT H
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-8838
Practice Address - Country:US
Practice Address - Phone:815-521-0111
Practice Address - Fax:815-521-0222
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR01028Medicare UPIN