Individual
DENA JASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
342 8TH AVE, LA GRANGE, IL 60525-6416
(773) 251-2567
Mailing address
342 8TH AVE, LA GRANGE, IL 60525-6416
(773) 251-2567
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160002464
IL
Other
Enumeration date
09/17/2013
Last updated
09/17/2013
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