Organization
SUPPLEMENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DAWN T AVITT ASSOCIATES (PTA)
(815) 458-2492
Entity
Organization
Contact information
Practice address
152 S WALKER ST, BRAIDWOOD, IL 60408-1952
(815) 458-2492
Mailing address
152 S WALKER ST, BRAIDWOOD, IL 60408-1952
(815) 458-2492
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
160.003259
IL
Other
Enumeration date
08/07/2012
Last updated
08/07/2012
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