Provider Demographics
NPI:1174872519
Name:SLABAUGH, DANA LYNN (PT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:SLABAUGH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10510 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-1263
Mailing Address - Country:US
Mailing Address - Phone:815-979-1711
Mailing Address - Fax:
Practice Address - Street 1:10510 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1263
Practice Address - Country:US
Practice Address - Phone:815-979-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700120882251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics