Provider Demographics
NPI:1942458351
Name:SPRAGUE, DON EUGENE (PTA)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:EUGENE
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 S FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-4010
Mailing Address - Country:US
Mailing Address - Phone:217-429-2551
Mailing Address - Fax:
Practice Address - Street 1:1790 S FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-4010
Practice Address - Country:US
Practice Address - Phone:217-429-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160002163225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant