Provider Demographics
NPI:1720325442
Name:MUYCO, DAN A (PT)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:A
Last Name:MUYCO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 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:630-759-3251
Practice Address - Street 1:420 W NORTHWEST HWY
Practice Address - Street 2:SUITE B
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6837
Practice Address - Country:US
Practice Address - Phone:847-382-3864
Practice Address - Fax:847-382-9347
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist