Provider Demographics
NPI:1972726313
Name:BESCIA, DAMON R (DPT OCS SCS FAAOMPT)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:R
Last Name:BESCIA
Suffix:
Gender:M
Credentials:DPT OCS SCS FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 SKYLANE DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9474
Mailing Address - Country:US
Mailing Address - Phone:630-408-9703
Mailing Address - Fax:888-480-9020
Practice Address - Street 1:2140 SKYLANE DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9474
Practice Address - Country:US
Practice Address - Phone:630-408-9703
Practice Address - Fax:888-480-9020
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X, 2251S0007X
IL70015648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
146639Medicare ID - Type Unspecified
IL214708012Medicare PIN
146639Medicare ID - Type Unspecified
IL202845053Medicare PIN
ILP00898827OtherMEDCIARE RAILROAD
IL216860032Medicare PIN
IL212622010Medicare PIN
IL209796010Medicare PIN
IL212623008Medicare PIN