Provider Demographics
NPI:1457546608
Name:DAY, NADINE KATHIE MIYOKO (MPT)
Entity type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:KATHIE MIYOKO
Last Name:DAY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 N VERMILION ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-1159
Mailing Address - Country:US
Mailing Address - Phone:217-446-7878
Mailing Address - Fax:217-446-7865
Practice Address - Street 1:3815 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1159
Practice Address - Country:US
Practice Address - Phone:217-446-7878
Practice Address - Fax:217-446-7865
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070 009850225100000X
IL060.007809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070 009850OtherSTATE LICENCE NUMBER
IL070 009850OtherSTATE LICENCE NUMBER
ILL84162Medicare PIN