Provider Demographics
NPI:1700167764
Name:GREVE, DOMINIQUE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:MARIE
Last Name:GREVE
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 1:45 WOODRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1546
Mailing Address - Country:US
Mailing Address - Phone:847-520-9092
Mailing Address - Fax:
Practice Address - Street 1:150 WEILAND RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-7047
Practice Address - Country:US
Practice Address - Phone:847-465-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist