Provider Demographics
NPI:1255561544
Name:DVORAK, CHRIS (PTA)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:DVORAK
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 1:1900 OGDEN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4273
Mailing Address - Country:US
Mailing Address - Phone:630-978-6218
Mailing Address - Fax:630-978-6219
Practice Address - Street 1:1900 OGDEN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4273
Practice Address - Country:US
Practice Address - Phone:630-978-6218
Practice Address - Fax:630-978-6219
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005273208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation