Provider Demographics
NPI:1780416859
Name:DEBLOIS, DAWN MICHELE (PTA)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELE
Last Name:DEBLOIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7432 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-2603
Mailing Address - Country:US
Mailing Address - Phone:245-323-9362
Mailing Address - Fax:
Practice Address - Street 1:424 N RAND RD
Practice Address - Street 2:
Practice Address - City:NORTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1496
Practice Address - Country:US
Practice Address - Phone:847-736-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.010075225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant