Provider Demographics
NPI:1790813921
Name:DOZIER, MARY LISSETTE (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LISSETTE
Last Name:DOZIER
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 1:6317 N TALMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1805
Mailing Address - Country:US
Mailing Address - Phone:312-855-1711
Mailing Address - Fax:312-855-9208
Practice Address - Street 1:25 E WASHINGTON STREET
Practice Address - Street 2:SUITE 1310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1708
Practice Address - Country:US
Practice Address - Phone:312-855-1711
Practice Address - Fax:312-855-9208
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist