Individual
DAWN MAUREEN TAN CLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2406 HARTLAND RD, WOODSTOCK, IL 60098-9763
(912) 380-0159
Mailing address
12262 WINNE LN, HUNTLEY, IL 60142-0045
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070019095
IL
225100000X
Physical Therapist
8218
CT
225100000X
Physical Therapist
PT009885
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070019095
ILLINOIS STATE BOARD OF PHYSICAL THERAPY
IL
01
—
8218
CONNECTICUT STATE BOARD OF PHYSICAL THERAPY
CT
01
—
PT009885
STATE BOARD OF PHYSICAL THERAPY
GA
Enumeration date
07/11/2010
Last updated
04/06/2020
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