Organization
DYNAMIC EASE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERRY ANNE DONTCHOS PT (OWNER)
(773) 248-2288
Entity
Organization
Contact information
Practice address
3424 N DAMEN AVE, CHICAGO, IL 60618-6106
(773) 248-2288
(773) 248-2282
Mailing address
3424 N DAMEN AVE, CHICAGO, IL 60618-6106
(773) 248-2288
(773) 248-2282
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
070009968
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635524
BCBS PROVIDER NUMBER
IL
Enumeration date
04/03/2007
Last updated
08/11/2011
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