Provider Demographics
NPI:1356369953
Name:DUSSIAS, MARIA (PT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DUSSIAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2304
Mailing Address - Country:US
Mailing Address - Phone:708-268-6588
Mailing Address - Fax:
Practice Address - Street 1:1131 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2304
Practice Address - Country:US
Practice Address - Phone:708-268-6588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070004973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623066OtherBCBS PROVIDER NUMBER
IL367885100OtherUS DEPT OF LABOR PROV
ILCJ4383OtherRAILROAD MEDICARE GROUP
IL567770Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILL75351Medicare PIN
IL568150OtherMEDICARE GROUP NUMBER
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL1619908OtherBCBS IL GROUP NUMBER
IL650021904OtherRAILROAD MEDICARE PIN
IL202542Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER