Provider Demographics
NPI:1861831232
Name:DAWSON, DIRK ASHLEY (DPT)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:ASHLEY
Last Name:DAWSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 KNOX ROAD 700 E
Mailing Address - Street 2:
Mailing Address - City:GILSON
Mailing Address - State:IL
Mailing Address - Zip Code:61436-9560
Mailing Address - Country:US
Mailing Address - Phone:309-337-3493
Mailing Address - Fax:
Practice Address - Street 1:144 JUNIOR AVE
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-2554
Practice Address - Country:US
Practice Address - Phone:309-853-4429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist