Provider Demographics
NPI:1295929396
Name:ADOLPH, DANIELLE M (DPT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:ADOLPH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:DEVICCHIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:2081 RIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-8848
Practice Address - Country:US
Practice Address - Phone:815-467-1612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-015921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01048510OtherMEDICARE RAILROAD
ILP01328076OtherRAILROAD MEDICARE
ILR01922Medicare PIN
ILIL3585001Medicare PIN
ILF400134401Medicare PIN
ILP01328076OtherRAILROAD MEDICARE
ILP01048510OtherMEDICARE RAILROAD