Provider Demographics
NPI:1831689637
Name:AUGELLI-WASHKO, DENISE (PTA)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:AUGELLI-WASHKO
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 1:10902 RED HAWK LN
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-9279
Mailing Address - Country:US
Mailing Address - Phone:815-997-7158
Mailing Address - Fax:
Practice Address - Street 1:2406 HARTLAND RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-9763
Practice Address - Country:US
Practice Address - Phone:815-338-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.001148225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty