Provider Demographics
NPI:1851404552
Name:DOLAN, JAMES LEONARD (ATC, PTA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEONARD
Last Name:DOLAN
Suffix:
Gender:M
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 VINEYARD DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5156
Mailing Address - Country:US
Mailing Address - Phone:847-721-6749
Mailing Address - Fax:
Practice Address - Street 1:1508 VINEYARD DR
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5156
Practice Address - Country:US
Practice Address - Phone:847-367-9924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer