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Individual

DONALD DAMRON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
111 SPRING ST, STREATOR, IL 61364-3332
(815) 673-4549
Mailing address
111 SPRING ST, STREATOR, IL 61364-3332
(815) 673-4549

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070-012891
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
070-012891
PT STATE LICENSE #
IL
Enumeration date
01/10/2007
Last updated
06/28/2012
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